How much rates vary
Facilitymedian $525 · 10th to 90th $100 to $4,898Professionalmedian $120 · 10th to 90th $83 to $214
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 $120.23 Median $3,630.78 Typical High $8,511.38 | Facility | None | $120.23 | $3,630.78 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $83.18 Median $120.23 Typical High $154.88 | Professional | None | $83.18 | $120.23 | $154.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $57.54 Median $85.11 Typical High $87.10 | Professional | 78 · Unplanned return to OR | $57.54 | $85.11 | $87.10 |
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 $162.18 Median $204.17 Typical High $204.17 | Professional | None | $162.18 | $204.17 | $204.17 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $109.65 Median $173.78 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $109.65 | $173.78 | $204.17 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $380.19 Typical High $851.14 | Facility | None | $100.00 | $380.19 | $851.14 |
Cigna Setting Professional Modifier None Typical Low $83.18 Median $120.23 Typical High $223.87 | Professional | None | $83.18 | $120.23 | $223.87 |
Emblem Health Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $234.42 | Professional | None | $229.09 | $229.09 | $234.42 |
Geisinger Setting Facility Modifier None Typical Low $91.20 Median $114.82 Typical High $199.53 | Facility | None | $91.20 | $114.82 | $199.53 |
Geisinger Setting Professional Modifier None Typical Low $87.10 Median $147.91 Typical High $239.88 | Professional | None | $87.10 | $147.91 | $239.88 |
Martin's Point Setting Facility Modifier None Typical Low $120.23 Median $3,630.78 Typical High $8,709.64 | Facility | None | $120.23 | $3,630.78 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $83.18 Median $120.23 Typical High $158.49 | Professional | None | $83.18 | $120.23 | $158.49 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $57.54 Median $81.28 Typical High $87.10 | Professional | 78 · Unplanned return to OR | $57.54 | $81.28 | $87.10 |
Oscar Health Setting Professional Modifier None Typical Low $162.18 Median $281.84 Typical High $302.00 | Professional | None | $162.18 | $281.84 | $302.00 |
UPMC Health Plan Setting Facility Modifier None Typical Low $112.20 Median $281.84 Typical High $436.52 | Facility | None | $112.20 | $281.84 | $436.52 |
UPMC Health Plan Setting Professional Modifier None Typical Low $93.33 Median $131.83 Typical High $281.84 | Professional | None | $93.33 | $131.83 | $281.84 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,890.45 | Facility | None | $416.87 | $724.44 | $3,890.45 |
United Setting Professional Modifier None Typical Low $91.20 Median $125.89 Typical High $218.78 | Professional | None | $91.20 | $125.89 | $218.78 |
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 $41.69 Median $60.26 Typical High $61.66 | Professional | 52 · Reduced service | $41.69 | $60.26 | $61.66 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $24.55 Typical High $24.55 | Professional | 53 · Discontinued | $16.60 | $24.55 | $24.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $91.20 Typical High $93.33 | Professional | 54 · Surgery only | $61.66 | $91.20 | $93.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $18.20 Typical High $18.62 | Professional | 55 · Aftercare only | $12.30 | $18.20 | $18.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $12.02 Typical High $12.30 | Professional | 56 · Pre-op care only | $8.32 | $12.02 | $12.30 |
Highmark BCBS Setting Facility Modifier PN · Off-campus dept, non-excepted Typical Low $1,174.90 Median $1,174.90 Typical High $1,174.90 | Facility | PN · Off-campus dept, non-excepted | $1,174.90 | $1,174.90 | $1,174.90 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $41.69 Median $57.54 Typical High $61.66 | Professional | 52 · Reduced service | $41.69 | $57.54 | $61.66 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $23.44 Typical High $24.55 | Professional | 53 · Discontinued | $16.60 | $23.44 | $24.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $87.10 Typical High $93.33 | Professional | 54 · Surgery only | $61.66 | $87.10 | $93.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $17.38 Typical High $18.62 | Professional | 55 · Aftercare only | $12.30 | $17.38 | $18.62 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $11.75 Typical High $12.30 | Professional | 56 · Pre-op care only | $8.32 | $11.75 | $12.30 |
Where Pennsylvania sits
The same service costs 3.5 times more in Wisconsin than in Kentucky. 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· 47th of 51
$123
WI $398KY $115
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.