How much rates vary
Facilitymedian $1,148 · 10th to 90th $355 to $4,898Professionalmedian $204 · 10th to 90th $151 to $355
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 $199.53 Median $1,995.26 Typical High $8,317.64 | Facility | None | $199.53 | $1,995.26 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $151.36 Median $199.53 Typical High $288.40 | Professional | None | $151.36 | $199.53 | $288.40 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $138.04 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $104.71 | $138.04 | $141.25 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $6,025.60 Typical High $8,709.64 | Facility | None | $3,981.07 | $6,025.60 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Professional | None | $407.38 | $407.38 | $407.38 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $281.84 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $177.83 | $281.84 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $338.84 Median $1,047.13 Typical High $1,819.70 | Facility | None | $338.84 | $1,047.13 | $1,819.70 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $213.80 Typical High $363.08 | Professional | None | $147.91 | $213.80 | $363.08 |
Emblem Health Setting Professional Modifier None Typical Low $363.08 Median $363.08 Typical High $380.19 | Professional | None | $363.08 | $363.08 | $380.19 |
Geisinger Setting Facility Modifier None Typical Low $1,096.48 Median $1,380.38 Typical High $2,398.83 | Facility | None | $1,096.48 | $1,380.38 | $2,398.83 |
Geisinger Setting Professional Modifier None Typical Low $154.88 Median $251.19 Typical High $380.19 | Professional | None | $154.88 | $251.19 | $380.19 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,698.24 Median $6,025.60 Typical High $7,244.36 | Facility | None | $1,698.24 | $6,025.60 | $7,244.36 |
Martin's Point Setting Facility Modifier None Typical Low $199.53 Median $1,995.26 Typical High $8,317.64 | Facility | None | $199.53 | $1,995.26 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $151.36 Median $199.53 Typical High $302.00 | Professional | None | $151.36 | $199.53 | $302.00 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $138.04 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $104.71 | $138.04 | $141.25 |
Oscar Health Setting Professional Modifier None Typical Low $263.03 Median $346.74 Typical High $446.68 | Professional | None | $263.03 | $346.74 | $446.68 |
UPMC Health Plan Setting Facility Modifier None Typical Low $190.55 Median $812.83 Typical High $1,862.09 | Facility | None | $190.55 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $165.96 Median $208.93 Typical High $281.84 | Professional | None | $165.96 | $208.93 | $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 $165.96 Median $223.87 Typical High $380.19 | Professional | None | $165.96 | $223.87 | $380.19 |
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 $74.13 Median $100.00 Typical High $102.33 | Professional | 52 · Reduced service | $74.13 | $100.00 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $39.81 Typical High $40.74 | Professional | 53 · Discontinued | $30.20 | $39.81 | $40.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $147.91 Typical High $151.36 | Professional | 54 · Surgery only | $112.20 | $147.91 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $29.51 Typical High $30.20 | Professional | 55 · Aftercare only | $22.39 | $29.51 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $19.95 Typical High $20.42 | Professional | 56 · Pre-op care only | $15.14 | $19.95 | $20.42 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $74.13 Median $100.00 Typical High $102.33 | Professional | 52 · Reduced service | $74.13 | $100.00 | $102.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $39.81 Typical High $40.74 | Professional | 53 · Discontinued | $30.20 | $39.81 | $40.74 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $147.91 Typical High $151.36 | Professional | 54 · Surgery only | $112.20 | $147.91 | $151.36 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $29.51 Typical High $30.20 | Professional | 55 · Aftercare only | $22.39 | $29.51 | $30.20 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $19.95 Typical High $20.42 | Professional | 56 · Pre-op care only | $15.14 | $19.95 | $20.42 |
Where Pennsylvania sits
The same service costs 4.6 times more in Alaska 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· 48th of 51
$219
AK $912UT $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.