How much rates vary
Facilitymedian $1,738 · 10th to 90th $501 to $5,129Professionalmedian $501 · 10th to 90th $417 to $813
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 $537.03 Median $2,344.23 Typical High $8,317.64 | Facility | None | $537.03 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $416.87 Median $501.19 Typical High $512.86 | Professional | None | $416.87 | $501.19 | $512.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $346.74 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $288.40 | $346.74 | $346.74 |
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 $602.56 Median $602.56 Typical High $724.44 | Professional | None | $602.56 | $602.56 | $724.44 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $389.05 Median $616.60 Typical High $776.25 | Professional | 78 · Unplanned return to OR | $389.05 | $616.60 | $776.25 |
Cigna Setting Facility Modifier None Typical Low $338.84 Median $1,584.89 Typical High $2,754.23 | Facility | None | $338.84 | $1,584.89 | $2,754.23 |
Cigna Setting Professional Modifier None Typical Low $446.68 Median $489.78 Typical High $891.25 | Professional | None | $446.68 | $489.78 | $891.25 |
Emblem Health Setting Professional Modifier None Typical Low $676.08 Median $676.08 Typical High $724.44 | Professional | None | $676.08 | $676.08 | $724.44 |
Geisinger Setting Facility Modifier None Typical Low $1,659.59 Median $2,089.30 Typical High $3,630.78 | Facility | None | $1,659.59 | $2,089.30 | $3,630.78 |
Geisinger Setting Professional Modifier None Typical Low $436.52 Median $575.44 Typical High $933.25 | Professional | None | $436.52 | $575.44 | $933.25 |
Martin's Point Setting Facility Modifier None Typical Low $588.84 Median $2,344.23 Typical High $7,244.36 | Facility | None | $588.84 | $2,344.23 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $416.87 Median $501.19 Typical High $501.19 | Professional | None | $416.87 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $346.74 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $288.40 | $346.74 | $346.74 |
Oscar Health Setting Professional Modifier None Typical Low $537.03 Median $630.96 Typical High $1,023.29 | Professional | None | $537.03 | $630.96 | $1,023.29 |
UPMC Health Plan Setting Facility Modifier None Typical Low $446.68 Median $1,122.02 Typical High $2,187.76 | Facility | None | $446.68 | $1,122.02 | $2,187.76 |
UPMC Health Plan Setting Professional Modifier None Typical Low $446.68 Median $512.86 Typical High $512.86 | Professional | None | $446.68 | $512.86 | $512.86 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,897.79 | Facility | None | $812.83 | $1,318.26 | $4,897.79 |
United Setting Professional Modifier None Typical Low $436.52 Median $549.54 Typical High $933.25 | Professional | None | $436.52 | $549.54 | $933.25 |
11 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 $208.93 Median $251.19 Typical High $251.19 | Professional | 52 · Reduced service | $208.93 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $100.00 Typical High $100.00 | Professional | 53 · Discontinued | $83.18 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $309.03 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $61.66 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $50.12 Typical High $50.12 | Professional | 56 · Pre-op care only | $41.69 | $50.12 | $50.12 |
Highmark BCBS Setting Facility Modifier XP · Separate practitioner Typical Low $831.76 Median $831.76 Typical High $831.76 | Facility | XP · Separate practitioner | $831.76 | $831.76 | $831.76 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $208.93 Median $251.19 Typical High $251.19 | Professional | 52 · Reduced service | $208.93 | $251.19 | $251.19 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $100.00 Typical High $100.00 | Professional | 53 · Discontinued | $83.18 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $309.03 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $61.66 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $50.12 Typical High $50.12 | Professional | 56 · Pre-op care only | $41.69 | $50.12 | $50.12 |
Where Pennsylvania sits
The same service costs 4.5 times more in Wisconsin 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
WI $6,608MT $1,483
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.