How much rates vary
Facilitymedian $3,890 · 10th to 90th $1,318 to $8,511Professionalmedian $1,175 · 10th to 90th $1,000 to $2,188
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 $891.25 Median $3,890.45 Typical High $8,511.38 | Facility | None | $891.25 | $3,890.45 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,000.00 Median $1,096.48 Typical High $1,174.90 | Professional | None | $1,000.00 | $1,096.48 | $1,174.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $776.25 Typical High $831.76 | Professional | 78 · Unplanned return to OR | $691.83 | $776.25 | $831.76 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $10,715.19 Typical High $12,022.64 | Facility | None | $3,981.07 | $10,715.19 | $12,022.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,122.02 Median $1,148.15 Typical High $2,238.72 | Professional | None | $1,122.02 | $1,148.15 | $2,238.72 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $870.96 Typical High $1,698.24 | Professional | 78 · Unplanned return to OR | $851.14 | $870.96 | $1,698.24 |
Cigna Setting Facility Modifier None Typical Low $1,288.25 Median $3,548.13 Typical High $7,079.46 | Facility | None | $1,288.25 | $3,548.13 | $7,079.46 |
Cigna Setting Professional Modifier None Typical Low $1,071.52 Median $1,174.90 Typical High $2,454.71 | Professional | None | $1,071.52 | $1,174.90 | $2,454.71 |
Emblem Health Setting Professional Modifier None Typical Low $1,348.96 Median $1,905.46 Typical High $1,905.46 | Professional | None | $1,348.96 | $1,905.46 | $1,905.46 |
Geisinger Setting Facility Modifier None Typical Low $3,630.78 Median $4,466.84 Typical High $7,943.28 | Facility | None | $3,630.78 | $4,466.84 | $7,943.28 |
Geisinger Setting Professional Modifier None Typical Low $1,023.29 Median $1,348.96 Typical High $2,398.83 | Professional | None | $1,023.29 | $1,348.96 | $2,398.83 |
Highmark BCBS Setting Facility Modifier None Typical Low $5,888.44 Median $11,220.18 Typical High $37,153.52 | Facility | None | $5,888.44 | $11,220.18 | $37,153.52 |
Highmark BCBS Setting Professional Modifier None Typical Low $1,548.82 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,548.82 | $1,548.82 | $1,548.82 |
Martin's Point Setting Facility Modifier None Typical Low $954.99 Median $3,801.89 Typical High $8,511.38 | Facility | None | $954.99 | $3,801.89 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $1,000.00 Median $1,096.48 Typical High $1,174.90 | Professional | None | $1,000.00 | $1,096.48 | $1,174.90 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $741.31 Typical High $831.76 | Professional | 78 · Unplanned return to OR | $691.83 | $741.31 | $831.76 |
Oscar Health Setting Professional Modifier None Typical Low $1,288.25 Median $1,318.26 Typical High $2,290.87 | Professional | None | $1,288.25 | $1,318.26 | $2,290.87 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,071.52 Median $3,981.07 Typical High $6,606.93 | Facility | None | $1,071.52 | $3,981.07 | $6,606.93 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,071.52 Median $1,071.52 Typical High $1,071.52 | Professional | None | $1,071.52 | $1,071.52 | $1,071.52 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,235.94 Typical High $8,912.51 | Facility | None | $1,698.24 | $3,235.94 | $8,912.51 |
United Setting Professional Modifier None Typical Low $1,096.48 Median $1,479.11 Typical High $1,905.46 | Professional | None | $1,096.48 | $1,479.11 | $1,905.46 |
12 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 $501.19 Median $549.54 Typical High $588.84 | Professional | 52 · Reduced service | $501.19 | $549.54 | $588.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $218.78 Typical High $239.88 | Professional | 53 · Discontinued | $199.53 | $218.78 | $239.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $831.76 Typical High $891.25 | Professional | 54 · Surgery only | $741.31 | $831.76 | $891.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $165.96 Typical High $177.83 | Professional | 55 · Aftercare only | $147.91 | $165.96 | $177.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $109.65 Typical High $117.49 | Professional | 56 · Pre-op care only | $100.00 | $109.65 | $117.49 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,659.59 Median $1,737.80 Typical High $3,388.44 | Professional | 50 · Both sides | $1,659.59 | $1,737.80 | $3,388.44 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $501.19 Median $537.03 Typical High $588.84 | Professional | 52 · Reduced service | $501.19 | $537.03 | $588.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $213.80 Typical High $239.88 | Professional | 53 · Discontinued | $199.53 | $213.80 | $239.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $794.33 Typical High $891.25 | Professional | 54 · Surgery only | $741.31 | $794.33 | $891.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $158.49 Typical High $177.83 | Professional | 55 · Aftercare only | $147.91 | $158.49 | $177.83 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $107.15 Typical High $117.49 | Professional | 56 · Pre-op care only | $100.00 | $107.15 | $117.49 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $1,737.80 Median $1,737.80 Typical High $1,737.80 | Professional | 62 · Two surgeons | $1,737.80 | $1,737.80 | $1,737.80 |
Where Pennsylvania sits
The same service costs 5.0 times more in Colorado than in Kentucky. 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.
Physician feeFacility fee
CO $14,731KY $2,968
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.