How much rates vary
Facilitymedian $1,738 · 10th to 90th $447 to $5,370Professionalmedian $331 · 10th to 90th $282 to $603
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 $2,344.23 Typical High $8,317.64 | Facility | None | $537.03 | $2,344.23 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $288.40 Median $323.59 Typical High $346.74 | Professional | None | $288.40 | $323.59 | $346.74 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $199.53 Median $229.09 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $199.53 | $229.09 | $229.09 |
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 $562.34 Median $562.34 Typical High $56,234.13 | Professional | None | $562.34 | $562.34 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $263.03 Median $380.19 Typical High $467.74 | Professional | 78 · Unplanned return to OR | $263.03 | $380.19 | $467.74 |
Cigna Setting Facility Modifier None Typical Low $338.84 Median $1,621.81 Typical High $2,818.38 | Facility | None | $338.84 | $1,621.81 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $338.84 Typical High $660.69 | Professional | None | $281.84 | $338.84 | $660.69 |
Emblem Health Setting Professional Modifier None Typical Low $512.86 Median $512.86 Typical High $549.54 | Professional | None | $512.86 | $512.86 | $549.54 |
Geisinger Setting Facility Modifier None Typical Low $1,698.24 Median $2,089.30 Typical High $3,715.35 | Facility | None | $1,698.24 | $2,089.30 | $3,715.35 |
Geisinger Setting Professional Modifier None Typical Low $281.84 Median $407.38 Typical High $645.65 | Professional | None | $281.84 | $407.38 | $645.65 |
Highmark BCBS Setting Facility Modifier None Typical Low $8,912.51 Median $8,912.51 Typical High $11,481.54 | Facility | None | $8,912.51 | $8,912.51 | $11,481.54 |
Martin's Point Setting Facility Modifier None Typical Low $588.84 Median $2,344.23 Typical High $7,244.36 | Facility | None | $588.84 | $2,344.23 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $288.40 Median $323.59 Typical High $338.84 | Professional | None | $288.40 | $323.59 | $338.84 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $199.53 Median $229.09 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $199.53 | $229.09 | $229.09 |
Oscar Health Setting Professional Modifier None Typical Low $281.84 Median $331.13 Typical High $630.96 | Professional | None | $281.84 | $331.13 | $630.96 |
UPMC Health Plan Setting Facility Modifier None Typical Low $239.88 Median $1,122.02 Typical High $2,187.76 | Facility | None | $239.88 | $1,122.02 | $2,187.76 |
UPMC Health Plan Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $346.74 | Professional | None | $239.88 | $239.88 | $346.74 |
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 $309.03 Median $389.05 Typical High $660.69 | Professional | None | $309.03 | $389.05 | $660.69 |
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 $144.54 Median $162.18 Typical High $165.96 | Professional | 52 · Reduced service | $144.54 | $162.18 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $57.54 Median $64.57 Typical High $66.07 | Professional | 53 · Discontinued | $57.54 | $64.57 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $213.80 Median $245.47 Typical High $245.47 | Professional | 54 · Surgery only | $213.80 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $43.65 Median $48.98 Typical High $48.98 | Professional | 55 · Aftercare only | $43.65 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.84 Median $32.36 Typical High $33.11 | Professional | 56 · Pre-op care only | $28.84 | $32.36 | $33.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $144.54 Median $162.18 Typical High $162.18 | Professional | 52 · Reduced service | $144.54 | $162.18 | $162.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $57.54 Median $64.57 Typical High $66.07 | Professional | 53 · Discontinued | $57.54 | $64.57 | $66.07 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $213.80 Median $245.47 Typical High $245.47 | Professional | 54 · Surgery only | $213.80 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $43.65 Median $48.98 Typical High $48.98 | Professional | 55 · Aftercare only | $43.65 | $48.98 | $48.98 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $28.84 Median $32.36 Typical High $32.36 | Professional | 56 · Pre-op care only | $28.84 | $32.36 | $32.36 |
Where Pennsylvania sits
The same service costs 8.5 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· 46th of 51
$380
OK $2,138UT $251
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.