How much rates vary
Facilitymedian $2,138 · 10th to 90th $708 to $6,457Professionalmedian $513 · 10th to 90th $437 to $955
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 $588.84 Median $4,786.30 Typical High $8,511.38 | Facility | None | $588.84 | $4,786.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $436.52 Median $446.68 Typical High $602.56 | Professional | None | $436.52 | $446.68 | $602.56 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $316.23 Typical High $354.81 | Professional | 78 · Unplanned return to OR | $302.00 | $316.23 | $354.81 |
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 $489.78 Median $776.25 Typical High $977.24 | Professional | None | $489.78 | $776.25 | $977.24 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $398.11 Median $630.96 Typical High $776.25 | Professional | 78 · Unplanned return to OR | $398.11 | $630.96 | $776.25 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,698.24 Typical High $2,884.03 | Facility | None | $616.60 | $1,698.24 | $2,884.03 |
Cigna Setting Professional Modifier None Typical Low $467.74 Median $524.81 Typical High $933.25 | Professional | None | $467.74 | $524.81 | $933.25 |
Emblem Health Setting Professional Modifier None Typical Low $724.44 Median $724.44 Typical High $758.58 | Professional | None | $724.44 | $724.44 | $758.58 |
Geisinger Setting Facility Modifier None Typical Low $1,698.24 Median $2,137.96 Typical High $3,715.35 | Facility | None | $1,698.24 | $2,137.96 | $3,715.35 |
Geisinger Setting Professional Modifier None Typical Low $457.09 Median $602.56 Typical High $977.24 | Professional | None | $457.09 | $602.56 | $977.24 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,467.37 Median $3,801.89 Typical High $8,128.31 | Facility | None | $3,467.37 | $3,801.89 | $8,128.31 |
Martin's Point Setting Facility Modifier None Typical Low $588.84 Median $4,265.80 Typical High $8,511.38 | Facility | None | $588.84 | $4,265.80 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $436.52 Median $446.68 Typical High $602.56 | Professional | None | $436.52 | $446.68 | $602.56 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $316.23 Typical High $331.13 | Professional | 78 · Unplanned return to OR | $302.00 | $316.23 | $331.13 |
Oscar Health Setting Professional Modifier None Typical Low $562.34 Median $602.56 Typical High $1,071.52 | Professional | None | $562.34 | $602.56 | $1,071.52 |
UPMC Health Plan Setting Facility Modifier None Typical Low $478.63 Median $2,137.96 Typical High $4,265.80 | Facility | None | $478.63 | $2,137.96 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $478.63 Median $537.03 Typical High $537.03 | Professional | None | $478.63 | $537.03 | $537.03 |
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 $467.74 Median $575.44 Typical High $977.24 | Professional | None | $467.74 | $575.44 | $977.24 |
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 $213.80 Median $223.87 Typical High $251.19 | Professional | 52 · Reduced service | $213.80 | $223.87 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $87.10 Median $89.13 Typical High $100.00 | Professional | 53 · Discontinued | $87.10 | $89.13 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $323.59 Median $338.84 Typical High $380.19 | Professional | 54 · Surgery only | $323.59 | $338.84 | $380.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $64.57 Median $67.61 Typical High $75.86 | Professional | 55 · Aftercare only | $64.57 | $67.61 | $75.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $44.67 Typical High $50.12 | Professional | 56 · Pre-op care only | $43.65 | $44.67 | $50.12 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $741.31 Median $1,174.90 Typical High $1,479.11 | Professional | 50 · Both sides | $741.31 | $1,174.90 | $1,479.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $213.80 Median $223.87 Typical High $239.88 | Professional | 52 · Reduced service | $213.80 | $223.87 | $239.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $87.10 Median $89.13 Typical High $95.50 | Professional | 53 · Discontinued | $87.10 | $89.13 | $95.50 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $323.59 Median $338.84 Typical High $354.81 | Professional | 54 · Surgery only | $323.59 | $338.84 | $354.81 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $64.57 Median $67.61 Typical High $70.79 | Professional | 55 · Aftercare only | $64.57 | $67.61 | $70.79 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $44.67 Typical High $47.86 | Professional | 56 · Pre-op care only | $43.65 | $44.67 | $47.86 |
Where Pennsylvania sits
The same service costs 10.0 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· 44th of 51
$603
OK $3,631UT $363
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.