How much rates vary
Facilitymedian $646 · 10th to 90th $178 to $4,898Professionalmedian $200 · 10th to 90th $120 to $363
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 $114.82 Median $190.55 Typical High $245.47 | Professional | None | $114.82 | $190.55 | $245.47 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $81.28 Median $120.23 Typical High $162.18 | Professional | 78 · Unplanned return to OR | $81.28 | $120.23 | $162.18 |
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 $199.53 Median $331.13 Typical High $398.11 | Professional | None | $199.53 | $331.13 | $398.11 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $162.18 Median $263.03 Typical High $323.59 | Professional | 78 · Unplanned return to OR | $162.18 | $263.03 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $177.83 Median $426.58 Typical High $851.14 | Facility | None | $177.83 | $426.58 | $851.14 |
Cigna Setting Professional Modifier None Typical Low $120.23 Median $194.98 Typical High $346.74 | Professional | None | $120.23 | $194.98 | $346.74 |
Emblem Health Setting Professional Modifier None Typical Low $346.74 Median $346.74 Typical High $363.08 | Professional | None | $346.74 | $346.74 | $363.08 |
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 $128.82 Median $218.78 Typical High $354.81 | Professional | None | $128.82 | $218.78 | $354.81 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,905.46 Median $2,511.89 Typical High $5,248.07 | Facility | None | $1,905.46 | $2,511.89 | $5,248.07 |
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 $114.82 Median $190.55 Typical High $251.19 | Professional | None | $114.82 | $190.55 | $251.19 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $81.28 Median $120.23 Typical High $162.18 | Professional | 78 · Unplanned return to OR | $81.28 | $120.23 | $162.18 |
Oscar Health Setting Professional Modifier None Typical Low $144.54 Median $154.88 Typical High $416.87 | Professional | None | $144.54 | $154.88 | $416.87 |
UPMC Health Plan Setting Facility Modifier None Typical Low $117.49 Median $2,398.83 Typical High $5,623.41 | Facility | None | $117.49 | $2,398.83 | $5,623.41 |
UPMC Health Plan Setting Professional Modifier None Typical Low $117.49 Median $181.97 Typical High $204.17 | Professional | None | $117.49 | $181.97 | $204.17 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,467.37 | Facility | None | $416.87 | $724.44 | $3,467.37 |
United Setting Professional Modifier None Typical Low $117.49 Median $194.98 Typical High $323.59 | Professional | None | $117.49 | $194.98 | $323.59 |
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 $57.54 Median $87.10 Typical High $117.49 | Professional | 52 · Reduced service | $57.54 | $87.10 | $117.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $34.67 Typical High $46.77 | Professional | 53 · Discontinued | $22.91 | $34.67 | $46.77 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $128.82 Typical High $173.78 | Professional | 54 · Surgery only | $87.10 | $128.82 | $173.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $25.70 Typical High $34.67 | Professional | 55 · Aftercare only | $17.38 | $25.70 | $34.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $17.38 Typical High $23.44 | Professional | 56 · Pre-op care only | $11.48 | $17.38 | $23.44 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $302.00 Median $489.78 Typical High $602.56 | Professional | 50 · Both sides | $302.00 | $489.78 | $602.56 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $57.54 Median $87.10 Typical High $117.49 | Professional | 52 · Reduced service | $57.54 | $87.10 | $117.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $34.67 Typical High $46.77 | Professional | 53 · Discontinued | $22.91 | $34.67 | $46.77 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $128.82 Typical High $173.78 | Professional | 54 · Surgery only | $87.10 | $128.82 | $173.78 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $25.70 Typical High $34.67 | Professional | 55 · Aftercare only | $17.38 | $25.70 | $34.67 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $17.38 Typical High $23.44 | Professional | 56 · Pre-op care only | $11.48 | $17.38 | $23.44 |
Where Pennsylvania sits
The same service costs 3.9 times more in Oklahoma 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· 42nd of 51
$209
OK $646KY $166
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.