How much rates vary
Facilitymedian $1,862 · 10th to 90th $692 to $6,310Professionalmedian $479 · 10th to 90th $398 to $891
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 $537.03 Median $4,570.88 Typical High $8,511.38 | Facility | None | $537.03 | $4,570.88 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $398.11 Median $416.87 Typical High $645.65 | Professional | None | $398.11 | $416.87 | $645.65 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $275.42 Median $288.40 Typical High $323.59 | Professional | 78 · Unplanned return to OR | $275.42 | $288.40 | $323.59 |
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 $457.09 Median $758.58 Typical High $977.24 | Professional | None | $457.09 | $758.58 | $977.24 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $363.08 Median $602.56 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $363.08 | $602.56 | $794.33 |
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 $426.58 Median $478.63 Typical High $870.96 | Professional | None | $426.58 | $478.63 | $870.96 |
Emblem Health Setting Professional Modifier None Typical Low $660.69 Median $660.69 Typical High $707.95 | Professional | None | $660.69 | $660.69 | $707.95 |
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 $426.58 Median $549.54 Typical High $891.25 | Professional | None | $426.58 | $549.54 | $891.25 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,548.13 Median $7,244.36 Typical High $12,302.69 | Facility | None | $3,548.13 | $7,244.36 | $12,302.69 |
Martin's Point Setting Facility Modifier None Typical Low $537.03 Median $3,981.07 Typical High $8,511.38 | Facility | None | $537.03 | $3,981.07 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $398.11 Median $416.87 Typical High $660.69 | Professional | None | $398.11 | $416.87 | $660.69 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $275.42 Median $288.40 Typical High $309.03 | Professional | 78 · Unplanned return to OR | $275.42 | $288.40 | $309.03 |
Oscar Health Setting Professional Modifier None Typical Low $524.81 Median $549.54 Typical High $1,000.00 | Professional | None | $524.81 | $549.54 | $1,000.00 |
UPMC Health Plan Setting Facility Modifier None Typical Low $436.52 Median $2,137.96 Typical High $4,168.69 | Facility | None | $436.52 | $2,137.96 | $4,168.69 |
UPMC Health Plan Setting Professional Modifier None Typical Low $436.52 Median $478.63 Typical High $478.63 | Professional | None | $436.52 | $478.63 | $478.63 |
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 $426.58 Median $524.81 Typical High $912.01 | Professional | None | $426.58 | $524.81 | $912.01 |
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 $199.53 Median $208.93 Typical High $234.42 | Professional | 52 · Reduced service | $199.53 | $208.93 | $234.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $79.43 Median $83.18 Typical High $93.33 | Professional | 53 · Discontinued | $79.43 | $83.18 | $93.33 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $295.12 Median $309.03 Typical High $346.74 | Professional | 54 · Surgery only | $295.12 | $309.03 | $346.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $61.66 Typical High $69.18 | Professional | 55 · Aftercare only | $60.26 | $61.66 | $69.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $39.81 Median $41.69 Typical High $46.77 | Professional | 56 · Pre-op care only | $39.81 | $41.69 | $46.77 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $676.08 Median $1,122.02 Typical High $1,479.11 | Professional | 50 · Both sides | $676.08 | $1,122.02 | $1,479.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $199.53 Median $208.93 Typical High $218.78 | Professional | 52 · Reduced service | $199.53 | $208.93 | $218.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $79.43 Median $83.18 Typical High $87.10 | Professional | 53 · Discontinued | $79.43 | $83.18 | $87.10 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $295.12 Median $309.03 Typical High $331.13 | Professional | 54 · Surgery only | $295.12 | $309.03 | $331.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $61.66 Typical High $66.07 | Professional | 55 · Aftercare only | $60.26 | $61.66 | $66.07 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $39.81 Median $41.69 Typical High $43.65 | Professional | 56 · Pre-op care only | $39.81 | $41.69 | $43.65 |
Where Pennsylvania sits
The same service costs 8.7 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· 40th of 51
$589
OK $2,951UT $339
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.