How much rates vary
Facilitymedian $871 · 10th to 90th $257 to $5,370Professionalmedian $295 · 10th to 90th $191 to $372
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 $338.84 Median $3,801.89 Typical High $8,317.64 | Facility | None | $338.84 | $3,801.89 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $190.55 Median $275.42 Typical High $338.84 | Professional | None | $190.55 | $275.42 | $338.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $131.83 Median $194.98 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $131.83 | $194.98 | $239.88 |
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 $295.12 Median $302.00 Typical High $446.68 | Professional | None | $295.12 | $302.00 | $446.68 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $204.17 Median $213.80 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $204.17 | $213.80 | $302.00 |
Cigna Setting Facility Modifier None Typical Low $257.04 Median $489.78 Typical High $851.14 | Facility | None | $257.04 | $489.78 | $851.14 |
Cigna Setting Professional Modifier None Typical Low $169.82 Median $245.47 Typical High $371.54 | Professional | None | $169.82 | $245.47 | $371.54 |
Emblem Health Setting Professional Modifier None Typical Low $380.19 Median $380.19 Typical High $524.81 | Professional | None | $380.19 | $380.19 | $524.81 |
Geisinger Setting Facility Modifier None Typical Low $229.09 Median $288.40 Typical High $512.86 | Facility | None | $229.09 | $288.40 | $512.86 |
Geisinger Setting Professional Modifier None Typical Low $245.47 Median $354.81 Typical High $537.03 | Professional | None | $245.47 | $354.81 | $537.03 |
Martin's Point Setting Facility Modifier None Typical Low $588.84 Median $3,715.35 Typical High $8,317.64 | Facility | None | $588.84 | $3,715.35 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $190.55 Median $275.42 Typical High $338.84 | Professional | None | $190.55 | $275.42 | $338.84 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $131.83 Median $194.98 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $131.83 | $194.98 | $239.88 |
Oscar Health Setting Professional Modifier None Typical Low $446.68 Median $446.68 Typical High $478.63 | Professional | None | $446.68 | $446.68 | $478.63 |
UPMC Health Plan Setting Facility Modifier None Typical Low $257.04 Median $524.81 Typical High $954.99 | Facility | None | $257.04 | $524.81 | $954.99 |
UPMC Health Plan Setting Professional Modifier None Typical Low $190.55 Median $288.40 Typical High $524.81 | Professional | None | $190.55 | $288.40 | $524.81 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,265.80 | Facility | None | $812.83 | $1,318.26 | $4,265.80 |
United Setting Professional Modifier None Typical Low $190.55 Median $275.42 Typical High $407.38 | Professional | None | $190.55 | $275.42 | $407.38 |
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 $95.50 Median $138.04 Typical High $169.82 | Professional | 52 · Reduced service | $95.50 | $138.04 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $54.95 Typical High $69.18 | Professional | 53 · Discontinued | $38.02 | $54.95 | $69.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $208.93 Typical High $257.04 | Professional | 54 · Surgery only | $141.25 | $208.93 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $41.69 Typical High $51.29 | Professional | 55 · Aftercare only | $28.18 | $41.69 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $27.54 Typical High $33.88 | Professional | 56 · Pre-op care only | $19.05 | $27.54 | $33.88 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $436.52 Median $457.09 Typical High $645.65 | Professional | 50 · Both sides | $436.52 | $457.09 | $645.65 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $95.50 Median $138.04 Typical High $169.82 | Professional | 52 · Reduced service | $95.50 | $138.04 | $169.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $54.95 Typical High $69.18 | Professional | 53 · Discontinued | $38.02 | $54.95 | $69.18 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $208.93 Typical High $257.04 | Professional | 54 · Surgery only | $141.25 | $208.93 | $257.04 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $41.69 Typical High $51.29 | Professional | 55 · Aftercare only | $28.18 | $41.69 | $51.29 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $27.54 Typical High $33.88 | Professional | 56 · Pre-op care only | $19.05 | $27.54 | $33.88 |
Where Pennsylvania sits
The same service costs 4.2 times more in Wyoming than in Utah. 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· 40th of 51
$295
WY $912UT $219
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.