How much rates vary
Facilitymedian $550 · 10th to 90th $214 to $3,467Professionalmedian $219 · 10th to 90th $93 to $275
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 $275.42 Median $2,137.96 Typical High $8,317.64 | Facility | None | $275.42 | $2,137.96 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $93.33 Median $204.17 Typical High $275.42 | Professional | None | $93.33 | $204.17 | $275.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $64.57 Median $104.71 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $64.57 | $104.71 | $190.55 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,630.27 Median $3,019.95 Typical High $56,234.13 | Facility | None | $2,630.27 | $3,019.95 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $223.87 Median $234.42 Typical High $354.81 | Professional | None | $223.87 | $234.42 | $354.81 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $181.97 Median $186.21 Typical High $269.15 | Professional | 78 · Unplanned return to OR | $181.97 | $186.21 | $269.15 |
Cigna Setting Facility Modifier None Typical Low $218.78 Median $331.13 Typical High $562.34 | Facility | None | $218.78 | $331.13 | $562.34 |
Cigna Setting Professional Modifier None Typical Low $81.28 Median $177.83 Typical High $269.15 | Professional | None | $81.28 | $177.83 | $269.15 |
Emblem Health Setting Professional Modifier None Typical Low $295.12 Median $295.12 Typical High $407.38 | Professional | None | $295.12 | $295.12 | $407.38 |
Geisinger Setting Facility Modifier None Typical Low $199.53 Median $245.47 Typical High $436.52 | Facility | None | $199.53 | $245.47 | $436.52 |
Geisinger Setting Professional Modifier None Typical Low $93.33 Median $251.19 Typical High $389.05 | Professional | None | $93.33 | $251.19 | $389.05 |
Highmark BCBS Setting Facility Modifier None Typical Low $302.00 Median $302.00 Typical High $302.00 | Facility | None | $302.00 | $302.00 | $302.00 |
Martin's Point Setting Facility Modifier None Typical Low $426.58 Median $2,137.96 Typical High $7,244.36 | Facility | None | $426.58 | $2,137.96 | $7,244.36 |
Martin's Point Setting Professional Modifier None Typical Low $93.33 Median $204.17 Typical High $275.42 | Professional | None | $93.33 | $204.17 | $275.42 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $64.57 Median $104.71 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $64.57 | $104.71 | $190.55 |
Oscar Health Setting Professional Modifier None Typical Low $251.19 Median $251.19 Typical High $269.15 | Professional | None | $251.19 | $251.19 | $269.15 |
UPMC Health Plan Setting Facility Modifier None Typical Low $151.36 Median $416.87 Typical High $954.99 | Facility | None | $151.36 | $416.87 | $954.99 |
UPMC Health Plan Setting Professional Modifier None Typical Low $93.33 Median $229.09 Typical High $316.23 | Professional | None | $93.33 | $229.09 | $316.23 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $2,630.27 | Facility | None | $416.87 | $724.44 | $2,630.27 |
United Setting Professional Modifier None Typical Low $89.13 Median $177.83 Typical High $288.40 | Professional | None | $89.13 | $177.83 | $288.40 |
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 $46.77 Median $74.13 Typical High $138.04 | Professional | 52 · Reduced service | $46.77 | $74.13 | $138.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.62 Median $30.20 Typical High $54.95 | Professional | 53 · Discontinued | $18.62 | $30.20 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $112.20 Typical High $204.17 | Professional | 54 · Surgery only | $69.18 | $112.20 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.13 Median $22.39 Typical High $41.69 | Professional | 55 · Aftercare only | $14.13 | $22.39 | $41.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.33 Median $14.79 Typical High $27.54 | Professional | 56 · Pre-op care only | $9.33 | $14.79 | $27.54 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $338.84 Median $354.81 Typical High $512.86 | Professional | 50 · Both sides | $338.84 | $354.81 | $512.86 |
Highmark BCBS Setting Professional Modifier 50 · Both sides Typical Low $478.63 Median $478.63 Typical High $478.63 | Professional | 50 · Both sides | $478.63 | $478.63 | $478.63 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $46.77 Median $74.13 Typical High $138.04 | Professional | 52 · Reduced service | $46.77 | $74.13 | $138.04 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $18.62 Median $30.20 Typical High $54.95 | Professional | 53 · Discontinued | $18.62 | $30.20 | $54.95 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $112.20 Typical High $204.17 | Professional | 54 · Surgery only | $69.18 | $112.20 | $204.17 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $14.13 Median $22.39 Typical High $41.69 | Professional | 55 · Aftercare only | $14.13 | $22.39 | $41.69 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $9.33 Median $14.79 Typical High $27.54 | Professional | 56 · Pre-op care only | $9.33 | $14.79 | $27.54 |
Where Pennsylvania sits
The same service costs 5.6 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· 29th of 51
$224
AK $562KY $100
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.