How much rates vary
Facilitymedian $1,820 · 10th to 90th $537 to $5,754Professionalmedian $209 · 10th to 90th $174 to $363
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 $229.09 Median $2,951.21 Typical High $8,511.38 | Facility | None | $229.09 | $2,951.21 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $199.53 Typical High $229.09 | Professional | None | $162.18 | $199.53 | $229.09 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $138.04 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $114.82 | $138.04 | $158.49 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $6,025.60 Typical High $56,234.13 | Facility | None | $3,981.07 | $6,025.60 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $288.40 Median $288.40 Typical High $56,234.13 | Professional | None | $288.40 | $288.40 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $169.82 Median $269.15 Typical High $323.59 | Professional | 78 · Unplanned return to OR | $169.82 | $269.15 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $1,621.81 Typical High $2,754.23 | Facility | None | $478.63 | $1,621.81 | $2,754.23 |
Cigna Setting Professional Modifier None Typical Low $177.83 Median $218.78 Typical High $371.54 | Professional | None | $177.83 | $218.78 | $371.54 |
Emblem Health Setting Professional Modifier None Typical Low $354.81 Median $354.81 Typical High $371.54 | Professional | None | $354.81 | $354.81 | $371.54 |
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 $194.98 Median $263.03 Typical High $426.58 | Professional | None | $194.98 | $263.03 | $426.58 |
Highmark BCBS Setting Facility Modifier None Typical Low $5,128.61 Median $7,079.46 Typical High $12,882.50 | Facility | None | $5,128.61 | $7,079.46 | $12,882.50 |
Martin's Point Setting Facility Modifier None Typical Low $575.44 Median $2,691.53 Typical High $8,317.64 | Facility | None | $575.44 | $2,691.53 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $162.18 Median $199.53 Typical High $229.09 | Professional | None | $162.18 | $199.53 | $229.09 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $138.04 Typical High $158.49 | Professional | 78 · Unplanned return to OR | $114.82 | $138.04 | $158.49 |
Oscar Health Setting Professional Modifier None Typical Low $245.47 Median $346.74 Typical High $446.68 | Professional | None | $245.47 | $346.74 | $446.68 |
UPMC Health Plan Setting Facility Modifier None Typical Low $204.17 Median $2,238.72 Typical High $5,248.07 | Facility | None | $204.17 | $2,238.72 | $5,248.07 |
UPMC Health Plan Setting Professional Modifier None Typical Low $177.83 Median $218.78 Typical High $363.08 | Professional | None | $177.83 | $218.78 | $363.08 |
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 $181.97 Median $229.09 Typical High $389.05 | Professional | None | $181.97 | $229.09 | $389.05 |
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 $81.28 Median $97.72 Typical High $114.82 | Professional | 52 · Reduced service | $81.28 | $97.72 | $114.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $39.81 Typical High $45.71 | Professional | 53 · Discontinued | $32.36 | $39.81 | $45.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $147.91 Typical High $169.82 | Professional | 54 · Surgery only | $123.03 | $147.91 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $29.51 Typical High $33.88 | Professional | 55 · Aftercare only | $24.55 | $29.51 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $19.95 Typical High $22.91 | Professional | 56 · Pre-op care only | $16.22 | $19.95 | $22.91 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $81.28 Median $97.72 Typical High $114.82 | Professional | 52 · Reduced service | $81.28 | $97.72 | $114.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $39.81 Typical High $45.71 | Professional | 53 · Discontinued | $32.36 | $39.81 | $45.71 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $147.91 Typical High $169.82 | Professional | 54 · Surgery only | $123.03 | $147.91 | $169.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $29.51 Typical High $33.88 | Professional | 55 · Aftercare only | $24.55 | $29.51 | $33.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $19.95 Typical High $22.91 | Professional | 56 · Pre-op care only | $16.22 | $19.95 | $22.91 |
Where Pennsylvania sits
The same service costs 5.9 times more in Oklahoma than in Utah. 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.
Pennsylvania· 46th of 51
$229
OK $1,175UT $200
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.