How much rates vary
Facilitymedian $3,236 · 10th to 90th $1,380 to $9,120Professionalmedian $1,230 · 10th to 90th $1,175 to $1,479
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 $1,288.25 Median $5,754.40 Typical High $10,715.19 | Facility | None | $1,288.25 | $5,754.40 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $1,174.90 Median $1,202.26 Typical High $1,348.96 | Professional | None | $1,174.90 | $1,202.26 | $1,348.96 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $851.14 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $851.14 | $851.14 | $933.25 |
Ambetter Setting Professional Modifier None Typical Low $1,047.13 Median $1,318.26 Typical High $1,318.26 | Professional | None | $1,047.13 | $1,318.26 | $1,318.26 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $12,022.64 Typical High $56,234.13 | Facility | None | $3,981.07 | $12,022.64 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,230.27 Median $1,258.93 Typical High $1,905.46 | Professional | None | $1,230.27 | $1,258.93 | $1,905.46 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $891.25 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $851.14 | $891.25 | $1,230.27 |
Emblem Health Setting Professional Modifier None Typical Low $1,288.25 Median $1,288.25 Typical High $1,778.28 | Professional | None | $1,288.25 | $1,288.25 | $1,778.28 |
Geisinger Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $4,677.35 | Facility | None | $2,137.96 | $2,691.53 | $4,677.35 |
Geisinger Setting Professional Modifier None Typical Low $1,023.29 Median $1,202.26 Typical High $2,041.74 | Professional | None | $1,023.29 | $1,202.26 | $2,041.74 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,630.27 Median $6,025.60 Typical High $19,952.62 | Facility | None | $2,630.27 | $6,025.60 | $19,952.62 |
Highmark BCBS Setting Professional Modifier None Typical Low $891.25 Median $1,202.26 Typical High $1,288.25 | Professional | None | $891.25 | $1,202.26 | $1,288.25 |
Martin's Point Setting Facility Modifier None Typical Low $1,348.96 Median $5,370.32 Typical High $11,481.54 | Facility | None | $1,348.96 | $5,370.32 | $11,481.54 |
Martin's Point Setting Professional Modifier None Typical Low $1,202.26 Median $1,202.26 Typical High $1,348.96 | Professional | None | $1,202.26 | $1,202.26 | $1,348.96 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $851.14 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $851.14 | $851.14 | $933.25 |
Oscar Health Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,318.26 | Professional | None | $1,258.93 | $1,258.93 | $1,318.26 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,202.26 Median $3,388.44 Typical High $6,606.93 | Facility | None | $1,202.26 | $3,388.44 | $6,606.93 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,202.26 Median $1,202.26 Typical High $1,202.26 | Professional | None | $1,202.26 | $1,202.26 | $1,202.26 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,884.03 Typical High $6,918.31 | Facility | None | $1,380.38 | $2,884.03 | $6,918.31 |
United Setting Professional Modifier None Typical Low $1,000.00 Median $1,318.26 Typical High $1,949.84 | Professional | None | $1,000.00 | $1,318.26 | $1,949.84 |
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 $602.56 Median $602.56 Typical High $676.08 | Professional | 52 · Reduced service | $602.56 | $602.56 | $676.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $245.47 Typical High $269.15 | Professional | 53 · Discontinued | $239.88 | $245.47 | $269.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $912.01 Typical High $1,000.00 | Professional | 54 · Surgery only | $912.01 | $912.01 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $181.97 Typical High $204.17 | Professional | 55 · Aftercare only | $181.97 | $181.97 | $204.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $120.23 Typical High $134.90 | Professional | 56 · Pre-op care only | $120.23 | $120.23 | $134.90 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,819.70 Median $1,905.46 Typical High $2,818.38 | Professional | 50 · Both sides | $1,819.70 | $1,905.46 | $2,818.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $602.56 Median $602.56 Typical High $676.08 | Professional | 52 · Reduced service | $602.56 | $602.56 | $676.08 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $245.47 Typical High $269.15 | Professional | 53 · Discontinued | $239.88 | $245.47 | $269.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $912.01 Typical High $1,000.00 | Professional | 54 · Surgery only | $912.01 | $912.01 | $1,000.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $181.97 Typical High $204.17 | Professional | 55 · Aftercare only | $181.97 | $181.97 | $204.17 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $120.23 Typical High $134.90 | Professional | 56 · Pre-op care only | $120.23 | $120.23 | $134.90 |
Where Pennsylvania sits
The same service costs 3.5 times more in Wisconsin than in Montana. 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
WI $12,600MT $3,640
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.