How much rates vary
Facilitymedian $2,138 · 10th to 90th $813 to $6,457Professionalmedian $617 · 10th to 90th $501 to $1,175
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 $4,786.30 Typical High $8,511.38 | Facility | None | $812.83 | $4,786.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $501.19 Median $512.86 Typical High $630.96 | Professional | None | $501.19 | $512.86 | $630.96 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $346.74 Median $354.81 Typical High $398.11 | Professional | 78 · Unplanned return to OR | $346.74 | $354.81 | $398.11 |
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 $776.25 Median $812.83 Typical High $56,234.13 | Professional | None | $776.25 | $812.83 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $630.96 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $562.34 | $630.96 | $1,122.02 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,659.59 Typical High $2,818.38 | Facility | None | $616.60 | $1,659.59 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $537.03 Median $588.84 Typical High $1,071.52 | Professional | None | $537.03 | $588.84 | $1,071.52 |
Emblem Health Setting Professional Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,737.80 | Professional | None | $1,174.90 | $1,174.90 | $1,737.80 |
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 $977.24 Median $977.24 Typical High $1,905.46 | Professional | None | $977.24 | $977.24 | $1,905.46 |
Highmark BCBS Setting Facility Modifier None Typical Low $5,495.41 Median $9,332.54 Typical High $13,803.84 | Facility | None | $5,495.41 | $9,332.54 | $13,803.84 |
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 $501.19 Median $512.86 Typical High $630.96 | Professional | None | $501.19 | $512.86 | $630.96 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $346.74 Median $354.81 Typical High $371.54 | Professional | 78 · Unplanned return to OR | $346.74 | $354.81 | $371.54 |
Oscar Health Setting Professional Modifier None Typical Low $630.96 Median $1,000.00 Typical High $1,258.93 | Professional | None | $630.96 | $1,000.00 | $1,258.93 |
UPMC Health Plan Setting Facility Modifier None Typical Low $741.31 Median $2,137.96 Typical High $4,265.80 | Facility | None | $741.31 | $2,137.96 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $741.31 Median $1,047.13 Typical High $1,047.13 | Professional | None | $741.31 | $1,047.13 | $1,047.13 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,905.46 Typical High $6,025.60 | Facility | None | $1,148.15 | $1,905.46 | $6,025.60 |
United Setting Professional Modifier None Typical Low $630.96 Median $831.76 Typical High $1,412.54 | Professional | None | $630.96 | $831.76 | $1,412.54 |
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 $245.47 Median $257.04 Typical High $288.40 | Professional | 52 · Reduced service | $245.47 | $257.04 | $288.40 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $102.33 Typical High $114.82 | Professional | 53 · Discontinued | $100.00 | $102.33 | $114.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $371.54 Median $380.19 Typical High $426.58 | Professional | 54 · Surgery only | $371.54 | $380.19 | $426.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $74.13 Median $75.86 Typical High $85.11 | Professional | 55 · Aftercare only | $74.13 | $75.86 | $85.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $50.12 Median $51.29 Typical High $57.54 | Professional | 56 · Pre-op care only | $50.12 | $51.29 | $57.54 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $245.47 Median $257.04 Typical High $269.15 | Professional | 52 · Reduced service | $245.47 | $257.04 | $269.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $102.33 Typical High $107.15 | Professional | 53 · Discontinued | $100.00 | $102.33 | $107.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $371.54 Median $380.19 Typical High $398.11 | Professional | 54 · Surgery only | $371.54 | $380.19 | $398.11 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $74.13 Median $75.86 Typical High $79.43 | Professional | 55 · Aftercare only | $74.13 | $75.86 | $79.43 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $50.12 Median $51.29 Typical High $53.70 | Professional | 56 · Pre-op care only | $50.12 | $51.29 | $53.70 |
Where Pennsylvania sits
The same service costs 7.4 times more in Oklahoma than in New York. 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· 45th of 51
$832
OK $3,802NY $513
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.