How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,230 · 10th to 90th $1,023 to $2,138
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 $831.76 Median $3,801.89 Typical High $8,511.38 | Facility | None | $831.76 | $3,801.89 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,000.00 Median $1,122.02 Typical High $1,258.93 | Professional | None | $1,000.00 | $1,122.02 | $1,258.93 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $794.33 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $724.44 | $794.33 | $870.96 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $28,183.83 Typical High $56,234.13 | Facility | None | $3,981.07 | $28,183.83 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,202.26 Median $1,862.09 Typical High $2,290.87 | Professional | None | $1,202.26 | $1,862.09 | $2,290.87 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $1,412.54 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $912.01 | $1,412.54 | $1,737.80 |
Cigna Setting Facility Modifier None Typical Low $120.23 Median $676.08 Typical High $2,290.87 | Facility | None | $120.23 | $676.08 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $794.33 Median $1,174.90 Typical High $2,238.72 | Professional | None | $794.33 | $1,174.90 | $2,238.72 |
Emblem Health Setting Professional Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $2,187.76 | Professional | None | $1,949.84 | $1,949.84 | $2,187.76 |
Geisinger Setting Professional Modifier None Typical Low $870.96 Median $1,479.11 Typical High $2,089.30 | Professional | None | $870.96 | $1,479.11 | $2,089.30 |
Highmark BCBS Setting Facility Modifier None Typical Low $5,623.41 Median $5,623.41 Typical High $5,623.41 | Facility | None | $5,623.41 | $5,623.41 | $5,623.41 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $3,801.89 Typical High $8,709.64 | Facility | None | $831.76 | $3,801.89 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,000.00 Median $1,148.15 Typical High $1,258.93 | Professional | None | $1,000.00 | $1,148.15 | $1,258.93 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $794.33 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $724.44 | $794.33 | $870.96 |
Oscar Health Setting Professional Modifier None Typical Low $10.96 Median $1,148.15 Typical High $2,089.30 | Professional | None | $10.96 | $1,148.15 | $2,089.30 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,096.48 Median $1,096.48 Typical High $1,174.90 | Facility | None | $1,096.48 | $1,096.48 | $1,174.90 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,096.48 Median $1,096.48 Typical High $1,174.90 | Professional | None | $1,096.48 | $1,096.48 | $1,174.90 |
United Setting Facility Modifier None Typical Low $199.53 Median $562.34 Typical High $4,265.80 | Facility | None | $199.53 | $562.34 | $4,265.80 |
United Setting Professional Modifier None Typical Low $1,023.29 Median $1,479.11 Typical High $2,344.23 | Professional | None | $1,023.29 | $1,479.11 | $2,344.23 |
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 $512.86 Median $562.34 Typical High $616.60 | Professional | 52 · Reduced service | $512.86 | $562.34 | $616.60 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $204.17 Median $229.09 Typical High $245.47 | Professional | 53 · Discontinued | $204.17 | $229.09 | $245.47 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $851.14 Typical High $933.25 | Professional | 54 · Surgery only | $776.25 | $851.14 | $933.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $154.88 Median $169.82 Typical High $186.21 | Professional | 55 · Aftercare only | $154.88 | $169.82 | $186.21 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $102.33 Median $112.20 Typical High $123.03 | Professional | 56 · Pre-op care only | $102.33 | $112.20 | $123.03 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $512.86 Median $562.34 Typical High $616.60 | Professional | 52 · Reduced service | $512.86 | $562.34 | $616.60 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $204.17 Median $229.09 Typical High $245.47 | Professional | 53 · Discontinued | $204.17 | $229.09 | $245.47 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $851.14 Typical High $933.25 | Professional | 54 · Surgery only | $776.25 | $851.14 | $933.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $154.88 Median $169.82 Typical High $186.21 | Professional | 55 · Aftercare only | $154.88 | $169.82 | $186.21 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $102.33 Median $112.20 Typical High $123.03 | Professional | 56 · Pre-op care only | $102.33 | $112.20 | $123.03 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $1,023.29 Median $1,023.29 Typical High $1,023.29 | Professional | 62 · Two surgeons | $1,023.29 | $1,023.29 | $1,023.29 |
Where Pennsylvania sits
The same service costs 5.6 times more in Alaska 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
$1,230
AK $5,012UT $891
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.