How much rates vary
Facilitymedian $1,413 · 10th to 90th $537 to $6,026Professionalmedian $2,455 · 10th to 90th $2,344 to $4,074
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 $1,023.29 Median $4,897.79 Typical High $8,511.38 | Facility | None | $1,023.29 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $2,344.23 Median $2,454.71 Typical High $2,454.71 | Professional | None | $2,344.23 | $2,454.71 | $2,454.71 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,621.81 Median $1,737.80 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $1,621.81 | $1,737.80 | $1,737.80 |
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 $56,234.13 Median $56,234.13 Typical High $56,234.13 | Professional | None | $56,234.13 | $56,234.13 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,905.46 Median $1,995.26 Typical High $4,168.69 | Professional | 78 · Unplanned return to OR | $1,905.46 | $1,995.26 | $4,168.69 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,148.15 Typical High $2,187.76 | Facility | None | $616.60 | $1,148.15 | $2,187.76 |
Cigna Setting Professional Modifier None Typical Low $2,290.87 Median $2,454.71 Typical High $4,570.88 | Professional | None | $2,290.87 | $2,454.71 | $4,570.88 |
Emblem Health Setting Professional Modifier None Typical Low $4,073.80 Median $4,073.80 Typical High $4,073.80 | Professional | None | $4,073.80 | $4,073.80 | $4,073.80 |
Geisinger Setting Facility Modifier None Typical Low $1,096.48 Median $1,380.38 Typical High $2,398.83 | Facility | None | $1,096.48 | $1,380.38 | $2,398.83 |
Geisinger Setting Professional Modifier None Typical Low $2,290.87 Median $3,235.94 Typical High $5,011.87 | Professional | None | $2,290.87 | $3,235.94 | $5,011.87 |
Martin's Point Setting Facility Modifier None Typical Low $1,023.29 Median $4,786.30 Typical High $8,511.38 | Facility | None | $1,023.29 | $4,786.30 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $2,344.23 Median $2,454.71 Typical High $2,454.71 | Professional | None | $2,344.23 | $2,454.71 | $2,454.71 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,621.81 Median $1,737.80 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $1,621.81 | $1,737.80 | $1,737.80 |
Oscar Health Setting Professional Modifier None Typical Low $2,884.03 Median $2,884.03 Typical High $5,248.07 | Professional | None | $2,884.03 | $2,884.03 | $5,248.07 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,548.82 Median $2,630.27 Typical High $4,265.80 | Facility | None | $1,548.82 | $2,630.27 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $2,630.27 Median $2,630.27 Typical High $2,630.27 | Professional | None | $2,630.27 | $2,630.27 | $2,630.27 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $3,890.45 | Facility | None | $416.87 | $724.44 | $3,890.45 |
United Setting Professional Modifier None Typical Low $2,290.87 Median $2,754.23 Typical High $5,128.61 | Professional | None | $2,290.87 | $2,754.23 | $5,128.61 |
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 $1,174.90 Median $1,230.27 Typical High $1,230.27 | Professional | 52 · Reduced service | $1,174.90 | $1,230.27 | $1,230.27 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $467.74 Median $489.78 Typical High $489.78 | Professional | 53 · Discontinued | $467.74 | $489.78 | $489.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,737.80 Median $1,862.09 Typical High $1,862.09 | Professional | 54 · Surgery only | $1,737.80 | $1,862.09 | $1,862.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $354.81 Median $371.54 Typical High $371.54 | Professional | 55 · Aftercare only | $354.81 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $234.42 Median $245.47 Typical High $245.47 | Professional | 56 · Pre-op care only | $234.42 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,174.90 Median $1,230.27 Typical High $1,230.27 | Professional | 52 · Reduced service | $1,174.90 | $1,230.27 | $1,230.27 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $467.74 Median $489.78 Typical High $489.78 | Professional | 53 · Discontinued | $467.74 | $489.78 | $489.78 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,737.80 Median $1,862.09 Typical High $1,862.09 | Professional | 54 · Surgery only | $1,737.80 | $1,862.09 | $1,862.09 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $354.81 Median $371.54 Typical High $371.54 | Professional | 55 · Aftercare only | $354.81 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $234.42 Median $245.47 Typical High $245.47 | Professional | 56 · Pre-op care only | $234.42 | $245.47 | $245.47 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $2,290.87 Median $2,290.87 Typical High $2,290.87 | Professional | 62 · Two surgeons | $2,290.87 | $2,290.87 | $2,290.87 |
Where Pennsylvania sits
The same service costs 15.8 times more in Alaska 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· 42nd of 51
$2,455
AK $8,128TX $513
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.