How much rates vary
Facilitymedian $3,802 · 10th to 90th $1,288 to $11,749Professionalmedian $1,259 · 10th to 90th $1,000 to $2,089
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 $1,258.93 Median $5,754.40 Typical High $10,715.19 | Facility | None | $1,258.93 | $5,754.40 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $1,000.00 Median $1,148.15 Typical High $1,288.25 | Professional | None | $1,000.00 | $1,148.15 | $1,288.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $707.95 Median $794.33 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $707.95 | $794.33 | $870.96 |
Capital Blue Cross Setting Facility Modifier None Typical Low $8,709.64 Median $47,863.01 Typical High $56,234.13 | Facility | None | $8,709.64 | $47,863.01 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,071.52 Median $1,698.24 Typical High $2,187.76 | Professional | None | $1,071.52 | $1,698.24 | $2,187.76 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $891.25 Median $1,380.38 Typical High $1,778.28 | Professional | 78 · Unplanned return to OR | $891.25 | $1,380.38 | $1,778.28 |
Cigna Setting Facility Modifier None Typical Low $5,370.32 Median $8,511.38 Typical High $11,748.98 | Facility | None | $5,370.32 | $8,511.38 | $11,748.98 |
Cigna Setting Professional Modifier None Typical Low $1,047.13 Median $1,202.26 Typical High $2,187.76 | Professional | None | $1,047.13 | $1,202.26 | $2,187.76 |
Emblem Health Setting Professional Modifier None Typical Low $1,445.44 Median $1,445.44 Typical High $1,698.24 | Professional | None | $1,445.44 | $1,445.44 | $1,698.24 |
Geisinger Setting Professional Modifier None Typical Low $1,000.00 Median $1,445.44 Typical High $2,344.23 | Professional | None | $1,000.00 | $1,445.44 | $2,344.23 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,630.27 Median $29,512.09 Typical High $107,151.93 | Facility | None | $2,630.27 | $29,512.09 | $107,151.93 |
Martin's Point Setting Facility Modifier None Typical Low $1,258.93 Median $5,495.41 Typical High $11,481.54 | Facility | None | $1,258.93 | $5,495.41 | $11,481.54 |
Martin's Point Setting Professional Modifier None Typical Low $1,000.00 Median $1,148.15 Typical High $1,288.25 | Professional | None | $1,000.00 | $1,148.15 | $1,288.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $707.95 Median $794.33 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $707.95 | $794.33 | $870.96 |
Oscar Health Setting Professional Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $2,344.23 | Professional | None | $1,230.27 | $1,230.27 | $2,344.23 |
UPMC Health Plan Setting Facility Modifier None Typical Low $954.99 Median $1,479.11 Typical High $2,344.23 | Facility | None | $954.99 | $1,479.11 | $2,344.23 |
UPMC Health Plan Setting Professional Modifier None Typical Low $954.99 Median $1,000.00 Typical High $1,047.13 | Professional | None | $954.99 | $1,000.00 | $1,047.13 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,235.94 Typical High $13,803.84 | Facility | None | $1,698.24 | $3,235.94 | $13,803.84 |
United Setting Professional Modifier None Typical Low $1,096.48 Median $1,445.44 Typical High $2,238.72 | Professional | None | $1,096.48 | $1,445.44 | $2,238.72 |
10 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 $501.19 Median $562.34 Typical High $630.96 | Professional | 52 · Reduced service | $501.19 | $562.34 | $630.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $229.09 Typical High $251.19 | Professional | 53 · Discontinued | $199.53 | $229.09 | $251.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $758.58 Median $851.14 Typical High $933.25 | Professional | 54 · Surgery only | $758.58 | $851.14 | $933.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $169.82 Typical High $186.21 | Professional | 55 · Aftercare only | $151.36 | $169.82 | $186.21 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $114.82 Typical High $125.89 | Professional | 56 · Pre-op care only | $100.00 | $114.82 | $125.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $501.19 Median $562.34 Typical High $630.96 | Professional | 52 · Reduced service | $501.19 | $562.34 | $630.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $229.09 Typical High $251.19 | Professional | 53 · Discontinued | $199.53 | $229.09 | $251.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $758.58 Median $851.14 Typical High $933.25 | Professional | 54 · Surgery only | $758.58 | $851.14 | $933.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $169.82 Typical High $186.21 | Professional | 55 · Aftercare only | $151.36 | $169.82 | $186.21 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $114.82 Typical High $125.89 | Professional | 56 · Pre-op care only | $100.00 | $114.82 | $125.89 |
Where Pennsylvania sits
The same service costs 8.9 times more in Oklahoma than in Texas. 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· 39th of 51
$1,413
OK $7,762TX $871
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.