How much rates vary
Facilitymedian $2,188 · 10th to 90th $933 to $6,761Professionalmedian $1,349 · 10th to 90th $1,175 to $1,698
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 $1,047.13 Median $5,495.41 Typical High $8,709.64 | Facility | None | $1,047.13 | $5,495.41 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $1,348.96 Median $1,348.96 Typical High $1,479.11 | Professional | None | $1,348.96 | $1,348.96 | $1,479.11 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $954.99 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $933.25 | $954.99 | $1,047.13 |
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 $1,348.96 Median $1,412.54 Typical High $2,187.76 | Professional | None | $1,348.96 | $1,412.54 | $2,187.76 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $977.24 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $954.99 | $977.24 | $1,348.96 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,737.80 Typical High $3,235.94 | Facility | None | $707.95 | $1,737.80 | $3,235.94 |
Cigna Setting Professional Modifier None Typical Low $1,047.13 Median $1,230.27 Typical High $1,862.09 | Professional | None | $1,047.13 | $1,230.27 | $1,862.09 |
Emblem Health Setting Professional Modifier None Typical Low $660.69 Median $1,348.96 Typical High $1,905.46 | Professional | None | $660.69 | $1,348.96 | $1,905.46 |
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 $1,148.15 Median $1,348.96 Typical High $2,398.83 | Professional | None | $1,148.15 | $1,348.96 | $2,398.83 |
Highmark BCBS Setting Facility Modifier None Typical Low $5,248.07 Median $5,248.07 Typical High $6,606.93 | Facility | None | $5,248.07 | $5,248.07 | $6,606.93 |
Highmark BCBS Setting Professional Modifier None Typical Low $1,621.81 Median $1,621.81 Typical High $1,698.24 | Professional | None | $1,621.81 | $1,621.81 | $1,698.24 |
Martin's Point Setting Facility Modifier None Typical Low $1,148.15 Median $4,897.79 Typical High $8,709.64 | Facility | None | $1,148.15 | $4,897.79 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,348.96 Median $1,348.96 Typical High $1,479.11 | Professional | None | $1,348.96 | $1,348.96 | $1,479.11 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $954.99 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $933.25 | $954.99 | $1,047.13 |
Oscar Health Setting Professional Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,288.25 | Professional | None | $1,230.27 | $1,230.27 | $1,288.25 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,258.93 Median $2,570.40 Typical High $5,011.87 | Facility | None | $1,258.93 | $2,570.40 | $5,011.87 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,348.96 | Professional | None | $1,258.93 | $1,258.93 | $1,348.96 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,862.09 Typical High $6,025.60 | Facility | None | $1,148.15 | $1,862.09 | $6,025.60 |
United Setting Professional Modifier None Typical Low $1,148.15 Median $1,513.56 Typical High $2,187.76 | Professional | None | $1,148.15 | $1,513.56 | $2,187.76 |
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 $676.08 Median $676.08 Typical High $741.31 | Professional | 52 · Reduced service | $676.08 | $676.08 | $741.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $269.15 Typical High $295.12 | Professional | 53 · Discontinued | $269.15 | $269.15 | $295.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,023.29 Typical High $1,122.02 | Professional | 54 · Surgery only | $1,000.00 | $1,023.29 | $1,122.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $204.17 Typical High $223.87 | Professional | 55 · Aftercare only | $199.53 | $204.17 | $223.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $134.90 Typical High $147.91 | Professional | 56 · Pre-op care only | $134.90 | $134.90 | $147.91 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $2,041.74 Median $2,089.30 Typical High $2,884.03 | Professional | 50 · Both sides | $2,041.74 | $2,089.30 | $2,884.03 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $676.08 Median $676.08 Typical High $741.31 | Professional | 52 · Reduced service | $676.08 | $676.08 | $741.31 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $269.15 Typical High $295.12 | Professional | 53 · Discontinued | $269.15 | $269.15 | $295.12 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,023.29 Typical High $1,122.02 | Professional | 54 · Surgery only | $1,000.00 | $1,023.29 | $1,122.02 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $204.17 Typical High $223.87 | Professional | 55 · Aftercare only | $199.53 | $204.17 | $223.87 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $134.90 Typical High $147.91 | Professional | 56 · Pre-op care only | $134.90 | $134.90 | $147.91 |
Where Pennsylvania sits
The same service costs 3.2 times more in Alaska than in Delaware. 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
AK $9,962DE $3,108
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.