How much rates vary
Facilitymedian $1,259 · 10th to 90th $380 to $4,074Professionalmedian $158 · 10th to 90th $102 to $200
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 $194.98 Median $2,137.96 Typical High $8,317.64 | Facility | None | $194.98 | $2,137.96 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $104.71 Median $154.88 Typical High $194.98 | Professional | None | $104.71 | $154.88 | $194.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $104.71 Typical High $138.04 | Professional | 78 · Unplanned return to OR | $74.13 | $104.71 | $138.04 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,511.89 Median $2,570.40 Typical High $56,234.13 | Facility | None | $2,511.89 | $2,570.40 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $169.82 Median $177.83 Typical High $269.15 | Professional | None | $169.82 | $177.83 | $269.15 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $141.25 Typical High $199.53 | Professional | 78 · Unplanned return to OR | $134.90 | $141.25 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $338.84 Median $1,174.90 Typical High $1,995.26 | Facility | None | $338.84 | $1,174.90 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $91.20 Median $138.04 Typical High $204.17 | Professional | None | $91.20 | $138.04 | $204.17 |
Emblem Health Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $302.00 | Professional | None | $218.78 | $218.78 | $302.00 |
Geisinger Setting Facility Modifier None Typical Low $1,230.27 Median $1,513.56 Typical High $2,691.53 | Facility | None | $1,230.27 | $1,513.56 | $2,691.53 |
Geisinger Setting Professional Modifier None Typical Low $107.15 Median $177.83 Typical High $288.40 | Professional | None | $107.15 | $177.83 | $288.40 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,122.02 Median $2,238.72 Typical High $3,311.31 | Facility | None | $1,122.02 | $2,238.72 | $3,311.31 |
Highmark BCBS Setting Professional Modifier None Typical Low $213.80 Median $213.80 Typical High $213.80 | Professional | None | $213.80 | $213.80 | $213.80 |
Martin's Point Setting Facility Modifier None Typical Low $478.63 Median $2,137.96 Typical High $7,244.36 | Facility | None | $478.63 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $104.71 Median $154.88 Typical High $194.98 | Professional | None | $104.71 | $154.88 | $194.98 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $74.13 Median $104.71 Typical High $138.04 | Professional | 78 · Unplanned return to OR | $74.13 | $104.71 | $138.04 |
Oscar Health Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $144.54 | Professional | None | $138.04 | $138.04 | $144.54 |
UPMC Health Plan Setting Facility Modifier None Typical Low $95.50 Median $812.83 Typical High $1,862.09 | Facility | None | $95.50 | $812.83 | $1,862.09 |
UPMC Health Plan Setting Professional Modifier None Typical Low $95.50 Median $125.89 Typical High $169.82 | Professional | None | $95.50 | $125.89 | $169.82 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,890.45 | Facility | None | $416.87 | $724.44 | $3,890.45 |
United Setting Professional Modifier None Typical Low $102.33 Median $147.91 Typical High $223.87 | Professional | None | $102.33 | $147.91 | $223.87 |
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 $52.48 Median $74.13 Typical High $97.72 | Professional | 52 · Reduced service | $52.48 | $74.13 | $97.72 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $30.20 Typical High $38.90 | Professional | 53 · Discontinued | $21.38 | $30.20 | $38.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $112.20 Typical High $147.91 | Professional | 54 · Surgery only | $79.43 | $112.20 | $147.91 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $22.39 Typical High $29.51 | Professional | 55 · Aftercare only | $15.85 | $22.39 | $29.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $14.79 Typical High $19.50 | Professional | 56 · Pre-op care only | $10.47 | $14.79 | $19.50 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $257.04 Median $263.03 Typical High $371.54 | Professional | 50 · Both sides | $257.04 | $263.03 | $371.54 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $52.48 Median $74.13 Typical High $97.72 | Professional | 52 · Reduced service | $52.48 | $74.13 | $97.72 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $30.20 Typical High $38.90 | Professional | 53 · Discontinued | $21.38 | $30.20 | $38.90 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $112.20 Typical High $147.91 | Professional | 54 · Surgery only | $79.43 | $112.20 | $147.91 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $22.39 Typical High $29.51 | Professional | 55 · Aftercare only | $15.85 | $22.39 | $29.51 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $14.79 Typical High $19.50 | Professional | 56 · Pre-op care only | $10.47 | $14.79 | $19.50 |
Where Pennsylvania sits
The same service costs 4.8 times more in Alaska 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.
Pennsylvania· 37th of 51
$170
AK $603KY $126
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.