How much rates vary
Facilitymedian $331 · 10th to 90th $100 to $3,890Professionalmedian $209 · 10th to 90th $129 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 $234.42 Median $3,090.30 Typical High $8,511.38 | Facility | None | $234.42 | $3,090.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $190.55 Typical High $251.19 | Professional | None | $120.23 | $190.55 | $251.19 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $125.89 Typical High $165.96 | Professional | 78 · Unplanned return to OR | $85.11 | $125.89 | $165.96 |
Ambetter Setting Professional Modifier None Typical Low $371.54 Median $371.54 Typical High $371.54 | Professional | None | $371.54 | $371.54 | $371.54 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $56,234.13 | Facility | None | $3,981.07 | $4,365.16 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $208.93 Median $338.84 Typical High $416.87 | Professional | None | $208.93 | $338.84 | $416.87 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $269.15 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $165.96 | $269.15 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $173.78 Median $426.58 Typical High $851.14 | Facility | None | $173.78 | $426.58 | $851.14 |
Cigna Setting Professional Modifier None Typical Low $128.82 Median $204.17 Typical High $354.81 | Professional | None | $128.82 | $204.17 | $354.81 |
Emblem Health Setting Professional Modifier None Typical Low $354.81 Median $354.81 Typical High $371.54 | Professional | None | $354.81 | $354.81 | $371.54 |
Geisinger Setting Facility Modifier None Typical Low $158.49 Median $199.53 Typical High $346.74 | Facility | None | $158.49 | $199.53 | $346.74 |
Geisinger Setting Professional Modifier None Typical Low $138.04 Median $229.09 Typical High $363.08 | Professional | None | $138.04 | $229.09 | $363.08 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $2,630.27 | Facility | None | $1,412.54 | $1,412.54 | $2,630.27 |
Martin's Point Setting Facility Modifier None Typical Low $575.44 Median $2,691.53 Typical High $8,317.64 | Facility | None | $575.44 | $2,691.53 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $120.23 Median $190.55 Typical High $263.03 | Professional | None | $120.23 | $190.55 | $263.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $125.89 Typical High $165.96 | Professional | 78 · Unplanned return to OR | $85.11 | $125.89 | $165.96 |
Oscar Health Setting Professional Modifier None Typical Low $147.91 Median $154.88 Typical High $436.52 | Professional | None | $147.91 | $154.88 | $436.52 |
UPMC Health Plan Setting Facility Modifier None Typical Low $134.90 Median $213.80 Typical High $398.11 | Facility | None | $134.90 | $213.80 | $398.11 |
UPMC Health Plan Setting Professional Modifier None Typical Low $131.83 Median $208.93 Typical High $213.80 | Professional | None | $131.83 | $208.93 | $213.80 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,698.24 | Facility | None | $77.62 | $158.49 | $1,698.24 |
United Setting Professional Modifier None Typical Low $125.89 Median $204.17 Typical High $331.13 | Professional | None | $125.89 | $204.17 | $331.13 |
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 $60.26 Median $91.20 Typical High $117.49 | Professional | 52 · Reduced service | $60.26 | $91.20 | $117.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $36.31 Typical High $46.77 | Professional | 53 · Discontinued | $23.99 | $36.31 | $46.77 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $134.90 Typical High $177.83 | Professional | 54 · Surgery only | $91.20 | $134.90 | $177.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $27.54 Typical High $35.48 | Professional | 55 · Aftercare only | $18.20 | $27.54 | $35.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $18.20 Typical High $23.44 | Professional | 56 · Pre-op care only | $12.02 | $18.20 | $23.44 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $309.03 Median $512.86 Typical High $630.96 | Professional | 50 · Both sides | $309.03 | $512.86 | $630.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $60.26 Median $91.20 Typical High $117.49 | Professional | 52 · Reduced service | $60.26 | $91.20 | $117.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $36.31 Typical High $46.77 | Professional | 53 · Discontinued | $23.99 | $36.31 | $46.77 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $134.90 Typical High $177.83 | Professional | 54 · Surgery only | $91.20 | $134.90 | $177.83 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $27.54 Typical High $35.48 | Professional | 55 · Aftercare only | $18.20 | $27.54 | $35.48 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $18.20 Typical High $23.44 | Professional | 56 · Pre-op care only | $12.02 | $18.20 | $23.44 |
Where Pennsylvania sits
The same service costs 3.5 times more in Wisconsin 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· 44th of 51
$209
WI $575KY $162
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.