How much rates vary
Facilitymedian $1,288 · 10th to 90th $490 to $5,012Professionalmedian $178 · 10th to 90th $155 to $324
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 $3,235.94 Typical High $8,511.38 | Facility | None | $588.84 | $3,235.94 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $147.91 Median $162.18 Typical High $204.17 | Professional | None | $147.91 | $162.18 | $204.17 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $102.33 Median $114.82 Typical High $120.23 | Professional | 78 · Unplanned return to OR | $102.33 | $114.82 | $120.23 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $56,234.13 | Facility | None | $3,981.07 | $4,365.16 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $257.04 Median $295.12 Typical High $323.59 | Professional | None | $257.04 | $295.12 | $323.59 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $144.54 Median $223.87 Typical High $263.03 | Professional | 78 · Unplanned return to OR | $144.54 | $223.87 | $263.03 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,202.26 Typical High $2,290.87 | Facility | None | $501.19 | $1,202.26 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $181.97 Typical High $346.74 | Professional | None | $158.49 | $181.97 | $346.74 |
Emblem Health Setting Professional Modifier None Typical Low $251.19 Median $251.19 Typical High $275.42 | Professional | None | $251.19 | $251.19 | $275.42 |
Geisinger Setting Facility Modifier None Typical Low $1,202.26 Median $1,513.56 Typical High $2,630.27 | Facility | None | $1,202.26 | $1,513.56 | $2,630.27 |
Geisinger Setting Professional Modifier None Typical Low $162.18 Median $213.80 Typical High $346.74 | Professional | None | $162.18 | $213.80 | $346.74 |
Martin's Point Setting Facility Modifier None Typical Low $724.44 Median $2,818.38 Typical High $8,317.64 | Facility | None | $724.44 | $2,818.38 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $147.91 Median $162.18 Typical High $194.98 | Professional | None | $147.91 | $162.18 | $194.98 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $102.33 Median $114.82 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $102.33 | $114.82 | $117.49 |
Oscar Health Setting Professional Modifier None Typical Low $190.55 Median $204.17 Typical High $331.13 | Professional | None | $190.55 | $204.17 | $331.13 |
UPMC Health Plan Setting Facility Modifier None Typical Low $173.78 Median $173.78 Typical High $177.83 | Facility | None | $173.78 | $173.78 | $177.83 |
UPMC Health Plan Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $177.83 | Professional | None | $173.78 | $173.78 | $177.83 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,981.07 | Facility | None | $416.87 | $724.44 | $3,981.07 |
United Setting Professional Modifier None Typical Low $162.18 Median $204.17 Typical High $354.81 | Professional | None | $162.18 | $204.17 | $354.81 |
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 $81.28 Typical High $85.11 | Professional | 52 · Reduced service | $74.13 | $81.28 | $85.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $29.51 Median $32.36 Typical High $34.67 | Professional | 53 · Discontinued | $29.51 | $32.36 | $34.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $123.03 Typical High $128.82 | Professional | 54 · Surgery only | $109.65 | $123.03 | $128.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $24.55 Typical High $25.70 | Professional | 55 · Aftercare only | $21.88 | $24.55 | $25.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.79 Median $16.22 Typical High $17.38 | Professional | 56 · Pre-op care only | $14.79 | $16.22 | $17.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $74.13 Median $81.28 Typical High $85.11 | Professional | 52 · Reduced service | $74.13 | $81.28 | $85.11 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $29.51 Median $32.36 Typical High $33.88 | Professional | 53 · Discontinued | $29.51 | $32.36 | $33.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $123.03 Typical High $125.89 | Professional | 54 · Surgery only | $109.65 | $123.03 | $125.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $24.55 Typical High $25.12 | Professional | 55 · Aftercare only | $21.88 | $24.55 | $25.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.79 Median $16.22 Typical High $16.98 | Professional | 56 · Pre-op care only | $14.79 | $16.22 | $16.98 |
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· 42nd of 51
$214
OK $1,349UT $155
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.