How much rates vary
Facilitymedian $2,239 · 10th to 90th $589 to $6,166Professionalmedian $1,995 · 10th to 90th $1,738 to $3,890
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 $4,897.79 Typical High $8,511.38 | Facility | None | $831.76 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,737.80 Median $1,862.09 Typical High $1,862.09 | Professional | None | $1,737.80 | $1,862.09 | $1,862.09 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,230.27 Median $1,288.25 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,230.27 | $1,288.25 | $1,288.25 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $28,183.83 Typical High $56,234.13 | Facility | None | $3,981.07 | $28,183.83 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,995.26 Median $3,235.94 Typical High $4,073.80 | Professional | None | $1,995.26 | $3,235.94 | $4,073.80 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,412.54 Median $2,290.87 Typical High $2,884.03 | Professional | 78 · Unplanned return to OR | $1,412.54 | $2,290.87 | $2,884.03 |
Cigna Setting Facility Modifier None Typical Low $120.23 Median $676.08 Typical High $2,290.87 | Facility | None | $120.23 | $676.08 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,778.28 Median $2,137.96 Typical High $4,073.80 | Professional | None | $1,778.28 | $2,137.96 | $4,073.80 |
Emblem Health Setting Professional Modifier None Typical Low $2,754.23 Median $2,754.23 Typical High $3,019.95 | Professional | None | $2,754.23 | $2,754.23 | $3,019.95 |
Geisinger Setting Professional Modifier None Typical Low $1,778.28 Median $2,398.83 Typical High $3,981.07 | Professional | None | $1,778.28 | $2,398.83 | $3,981.07 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $3,801.89 Typical High $8,709.64 | Facility | None | $831.76 | $3,801.89 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,737.80 Median $1,862.09 Typical High $1,862.09 | Professional | None | $1,737.80 | $1,862.09 | $1,862.09 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,230.27 Median $1,288.25 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,230.27 | $1,288.25 | $1,288.25 |
Oscar Health Setting Professional Modifier None Typical Low $2,290.87 Median $2,398.83 Typical High $4,073.80 | Professional | None | $2,290.87 | $2,398.83 | $4,073.80 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,949.84 Median $2,630.27 Typical High $4,365.16 | Facility | None | $1,949.84 | $2,630.27 | $4,365.16 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $1,949.84 | Professional | None | $1,949.84 | $1,949.84 | $1,949.84 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,398.83 Typical High $4,897.79 | Facility | None | $1,380.38 | $2,398.83 | $4,897.79 |
United Setting Professional Modifier None Typical Low $1,737.80 Median $2,137.96 Typical High $4,073.80 | Professional | None | $1,737.80 | $2,137.96 | $4,073.80 |
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 $870.96 Median $912.01 Typical High $912.01 | Professional | 52 · Reduced service | $870.96 | $912.01 | $912.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $354.81 Median $371.54 Typical High $371.54 | Professional | 53 · Discontinued | $354.81 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,318.26 Median $1,380.38 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,318.26 | $1,380.38 | $1,380.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $263.03 Median $275.42 Typical High $275.42 | Professional | 55 · Aftercare only | $263.03 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $173.78 Median $186.21 Typical High $186.21 | Professional | 56 · Pre-op care only | $173.78 | $186.21 | $186.21 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $3,019.95 Median $4,786.30 Typical High $6,025.60 | Professional | 50 · Both sides | $3,019.95 | $4,786.30 | $6,025.60 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $870.96 Median $912.01 Typical High $912.01 | Professional | 52 · Reduced service | $870.96 | $912.01 | $912.01 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $354.81 Median $371.54 Typical High $371.54 | Professional | 53 · Discontinued | $354.81 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,318.26 Median $1,380.38 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,318.26 | $1,380.38 | $1,380.38 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $263.03 Median $275.42 Typical High $275.42 | Professional | 55 · Aftercare only | $263.03 | $275.42 | $275.42 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $173.78 Median $186.21 Typical High $186.21 | Professional | 56 · Pre-op care only | $173.78 | $186.21 | $186.21 |
Where Pennsylvania sits
The same service costs 8.5 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· 44th of 51
$1,995
AK $8,128TX $955
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.