How much rates vary
Facilitymedian $1,514 · 10th to 90th $692 to $5,012Professionalmedian $832 · 10th to 90th $776 to $1,445
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 $831.76 Median $3,890.45 Typical High $8,317.64 | Facility | None | $831.76 | $3,890.45 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $794.33 Median $831.76 Typical High $831.76 | Professional | None | $794.33 | $831.76 | $831.76 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $588.84 Typical High $588.84 | Professional | 78 · Unplanned return to OR | $562.34 | $588.84 | $588.84 |
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 $1,513.56 Median $1,584.89 Typical High $56,234.13 | Professional | None | $1,513.56 | $1,584.89 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $645.65 Median $676.08 Typical High $1,548.82 | Professional | 78 · Unplanned return to OR | $645.65 | $676.08 | $1,548.82 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,096.48 Typical High $2,187.76 | Facility | None | $501.19 | $1,096.48 | $2,187.76 |
Cigna Setting Professional Modifier None Typical Low $776.25 Median $831.76 Typical High $1,548.82 | Professional | None | $776.25 | $831.76 | $1,548.82 |
Emblem Health Setting Professional Modifier None Typical Low $1,445.44 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,445.44 | $1,445.44 | $1,445.44 |
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 $758.58 Median $1,122.02 Typical High $1,778.28 | Professional | None | $758.58 | $1,122.02 | $1,778.28 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $3,801.89 Typical High $8,317.64 | Facility | None | $831.76 | $3,801.89 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $794.33 Median $831.76 Typical High $831.76 | Professional | None | $794.33 | $831.76 | $831.76 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $588.84 Typical High $588.84 | Professional | 78 · Unplanned return to OR | $562.34 | $588.84 | $588.84 |
Oscar Health Setting Professional Modifier None Typical Low $891.25 Median $891.25 Typical High $1,659.59 | Professional | None | $891.25 | $891.25 | $1,659.59 |
UPMC Health Plan Setting Facility Modifier None Typical Low $794.33 Median $1,737.80 Typical High $3,467.37 | Facility | None | $794.33 | $1,737.80 | $3,467.37 |
UPMC Health Plan Setting Professional Modifier None Typical Low $794.33 Median $891.25 Typical High $891.25 | Professional | None | $794.33 | $891.25 | $891.25 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $3,981.07 | Facility | None | $812.83 | $1,318.26 | $3,981.07 |
United Setting Professional Modifier None Typical Low $776.25 Median $912.01 Typical High $1,737.80 | Professional | None | $776.25 | $912.01 | $1,737.80 |
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 $398.11 Median $416.87 Typical High $416.87 | Professional | 52 · Reduced service | $398.11 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $165.96 Typical High $165.96 | Professional | 53 · Discontinued | $158.49 | $165.96 | $165.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $630.96 Typical High $630.96 | Professional | 54 · Surgery only | $602.56 | $630.96 | $630.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $125.89 Typical High $125.89 | Professional | 55 · Aftercare only | $120.23 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $83.18 Typical High $83.18 | Professional | 56 · Pre-op care only | $79.43 | $83.18 | $83.18 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $398.11 Median $416.87 Typical High $416.87 | Professional | 52 · Reduced service | $398.11 | $416.87 | $416.87 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $165.96 Typical High $165.96 | Professional | 53 · Discontinued | $158.49 | $165.96 | $165.96 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $630.96 Typical High $630.96 | Professional | 54 · Surgery only | $602.56 | $630.96 | $630.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $125.89 Typical High $125.89 | Professional | 55 · Aftercare only | $120.23 | $125.89 | $125.89 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $83.18 Typical High $83.18 | Professional | 56 · Pre-op care only | $79.43 | $83.18 | $83.18 |
Where Pennsylvania sits
The same service costs 7.6 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· 43rd of 51
$891
AK $3,715TX $490
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.