How much rates vary
Facilitymedian $955 · 10th to 90th $105 to $5,495Professionalmedian $141 · 10th to 90th $100 to $240
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 $154.88 Median $3,090.30 Typical High $8,511.38 | Facility | None | $154.88 | $3,090.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $100.00 Median $134.90 Typical High $158.49 | Professional | None | $100.00 | $134.90 | $158.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $66.07 Median $93.33 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $66.07 | $93.33 | $107.15 |
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 $144.54 Median $251.19 Typical High $251.19 | Professional | None | $144.54 | $251.19 | $251.19 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $128.82 Median $194.98 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $128.82 | $194.98 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $97.72 Median $380.19 Typical High $851.14 | Facility | None | $97.72 | $380.19 | $851.14 |
Cigna Setting Professional Modifier None Typical Low $112.20 Median $138.04 Typical High $263.03 | Professional | None | $112.20 | $138.04 | $263.03 |
Emblem Health Setting Professional Modifier None Typical Low $263.03 Median $263.03 Typical High $281.84 | Professional | None | $263.03 | $263.03 | $281.84 |
Geisinger Setting Facility Modifier None Typical Low $89.13 Median $109.65 Typical High $194.98 | Facility | None | $89.13 | $109.65 | $194.98 |
Geisinger Setting Professional Modifier None Typical Low $125.89 Median $177.83 Typical High $281.84 | Professional | None | $125.89 | $177.83 | $281.84 |
Highmark BCBS Setting Facility Modifier None Typical Low $14,125.38 Median $14,125.38 Typical High $14,125.38 | Facility | None | $14,125.38 | $14,125.38 | $14,125.38 |
Martin's Point Setting Facility Modifier None Typical Low $575.44 Median $2,691.53 Typical High $8,317.64 | Facility | None | $575.44 | $2,691.53 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $100.00 Median $134.90 Typical High $158.49 | Professional | None | $100.00 | $134.90 | $158.49 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $63.10 Median $93.33 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $63.10 | $93.33 | $107.15 |
Oscar Health Setting Professional Modifier None Typical Low $194.98 Median $199.53 Typical High $295.12 | Professional | None | $194.98 | $199.53 | $295.12 |
UPMC Health Plan Setting Facility Modifier None Typical Low $131.83 Median $2,398.83 Typical High $5,623.41 | Facility | None | $131.83 | $2,398.83 | $5,623.41 |
UPMC Health Plan Setting Professional Modifier None Typical Low $109.65 Median $158.49 Typical High $190.55 | Professional | None | $109.65 | $158.49 | $190.55 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,466.84 | Facility | None | $812.83 | $1,318.26 | $4,466.84 |
United Setting Professional Modifier None Typical Low $109.65 Median $154.88 Typical High $263.03 | Professional | None | $109.65 | $154.88 | $263.03 |
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 $46.77 Median $66.07 Typical High $77.62 | Professional | 52 · Reduced service | $46.77 | $66.07 | $77.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.62 Median $26.30 Typical High $30.90 | Professional | 53 · Discontinued | $18.62 | $26.30 | $30.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $70.79 Median $100.00 Typical High $114.82 | Professional | 54 · Surgery only | $70.79 | $100.00 | $114.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.13 Median $19.95 Typical High $22.91 | Professional | 55 · Aftercare only | $14.13 | $19.95 | $22.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.33 Median $13.18 Typical High $15.49 | Professional | 56 · Pre-op care only | $9.33 | $13.18 | $15.49 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $45.71 Median $66.07 Typical High $77.62 | Professional | 52 · Reduced service | $45.71 | $66.07 | $77.62 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $26.30 Typical High $30.90 | Professional | 53 · Discontinued | $18.20 | $26.30 | $30.90 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $100.00 Typical High $114.82 | Professional | 54 · Surgery only | $67.61 | $100.00 | $114.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $19.95 Typical High $22.91 | Professional | 55 · Aftercare only | $13.49 | $19.95 | $22.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $13.18 Typical High $15.49 | Professional | 56 · Pre-op care only | $9.12 | $13.18 | $15.49 |
Where Pennsylvania sits
The same service costs 3.6 times more in Wisconsin than in Texas. 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
$151
WI $468TX $129
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.