How much rates vary
Facilitymedian $1,445 · 10th to 90th $692 to $6,166Professionalmedian $316 · 10th to 90th $257 to $537
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $812.83 Median $4,897.79 Typical High $8,511.38 | Facility | None | $812.83 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $257.04 Median $316.23 Typical High $380.19 | Professional | None | $257.04 | $316.23 | $380.19 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $181.97 Median $218.78 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $181.97 | $218.78 | $218.78 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $56,234.13 | Facility | None | $3,981.07 | $7,413.10 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $234.42 Median $234.42 Typical High $56,234.13 | Professional | None | $234.42 | $234.42 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $245.47 Median $380.19 Typical High $467.74 | Professional | 78 · Unplanned return to OR | $245.47 | $380.19 | $467.74 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,047.13 Typical High $2,041.74 | Facility | None | $616.60 | $1,047.13 | $2,041.74 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $302.00 Typical High $562.34 | Professional | None | $281.84 | $302.00 | $562.34 |
Emblem Health Setting Professional Modifier None Typical Low $436.52 Median $436.52 Typical High $457.09 | Professional | None | $436.52 | $436.52 | $457.09 |
Geisinger Setting Facility Modifier None Typical Low $977.24 Median $1,202.26 Typical High $2,137.96 | Facility | None | $977.24 | $1,202.26 | $2,137.96 |
Geisinger Setting Professional Modifier None Typical Low $275.42 Median $363.08 Typical High $588.84 | Professional | None | $275.42 | $363.08 | $588.84 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,348.96 Median $4,365.16 Typical High $10,000.00 | Facility | None | $1,348.96 | $4,365.16 | $10,000.00 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $4,570.88 Typical High $8,511.38 | Facility | None | $831.76 | $4,570.88 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $257.04 Median $316.23 Typical High $389.05 | Professional | None | $257.04 | $316.23 | $389.05 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $181.97 Median $218.78 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $181.97 | $218.78 | $218.78 |
Oscar Health Setting Professional Modifier None Typical Low $338.84 Median $426.58 Typical High $645.65 | Professional | None | $338.84 | $426.58 | $645.65 |
UPMC Health Plan Setting Facility Modifier None Typical Low $281.84 Median $2,137.96 Typical High $4,265.80 | Facility | None | $281.84 | $2,137.96 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $281.84 Median $407.38 Typical High $407.38 | Professional | None | $281.84 | $407.38 | $407.38 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $3,981.07 | Facility | None | $812.83 | $1,318.26 | $3,981.07 |
United Setting Professional Modifier None Typical Low $275.42 Median $338.84 Typical High $575.44 | Professional | None | $275.42 | $338.84 | $575.44 |
10 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $128.82 Median $154.88 Typical High $154.88 | Professional | 52 · Reduced service | $128.82 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $51.29 Median $63.10 Typical High $63.10 | Professional | 53 · Discontinued | $51.29 | $63.10 | $63.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $194.98 Median $234.42 Typical High $234.42 | Professional | 54 · Surgery only | $194.98 | $234.42 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.90 Median $46.77 Typical High $46.77 | Professional | 55 · Aftercare only | $38.90 | $46.77 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $30.90 Typical High $31.62 | Professional | 56 · Pre-op care only | $25.70 | $30.90 | $31.62 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $128.82 Median $154.88 Typical High $154.88 | Professional | 52 · Reduced service | $128.82 | $154.88 | $154.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $51.29 Median $63.10 Typical High $63.10 | Professional | 53 · Discontinued | $51.29 | $63.10 | $63.10 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $194.98 Median $234.42 Typical High $234.42 | Professional | 54 · Surgery only | $194.98 | $234.42 | $234.42 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $38.90 Median $46.77 Typical High $46.77 | Professional | 55 · Aftercare only | $38.90 | $46.77 | $46.77 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $30.90 Typical High $31.62 | Professional | 56 · Pre-op care only | $25.70 | $30.90 | $31.62 |
Where Pennsylvania sits
The same service costs 6.6 times more in Oklahoma than in Montana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
Physician feeFacility fee
OK $6,126MT $925
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.