How much rates vary
Facilitymedian $5,012 · 10th to 90th $676 to $21,878Professionalmedian $4,074 · 10th to 90th $3,548 to $6,918
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 $3,548.13 Median $3,890.45 Typical High $4,073.80 | Professional | None | $3,548.13 | $3,890.45 | $4,073.80 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,454.71 Median $2,691.53 Typical High $2,818.38 | Professional | 78 · Unplanned return to OR | $2,454.71 | $2,691.53 | $2,818.38 |
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 $3,890.45 Median $4,073.80 Typical High $7,762.47 | Professional | None | $3,890.45 | $4,073.80 | $7,762.47 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,691.53 Median $2,818.38 Typical High $5,370.32 | Professional | 78 · Unplanned return to OR | $2,691.53 | $2,818.38 | $5,370.32 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $12,882.50 Typical High $22,387.21 | Facility | None | $549.54 | $12,882.50 | $22,387.21 |
Cigna Setting Professional Modifier None Typical Low $3,715.35 Median $3,981.07 Typical High $8,511.38 | Professional | None | $3,715.35 | $3,981.07 | $8,511.38 |
Emblem Health Setting Professional Modifier None Typical Low $4,466.84 Median $6,025.60 Typical High $6,025.60 | Professional | None | $4,466.84 | $6,025.60 | $6,025.60 |
Geisinger Setting Professional Modifier None Typical Low $3,548.13 Median $4,677.35 Typical High $8,511.38 | Professional | None | $3,548.13 | $4,677.35 | $8,511.38 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $4,073.80 Typical High $8,709.64 | Facility | None | $831.76 | $4,073.80 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $3,548.13 Median $3,801.89 Typical High $4,073.80 | Professional | None | $3,548.13 | $3,801.89 | $4,073.80 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,454.71 Median $2,630.27 Typical High $2,818.38 | Professional | 78 · Unplanned return to OR | $2,454.71 | $2,630.27 | $2,818.38 |
Oscar Health Setting Professional Modifier None Typical Low $4,466.84 Median $5,128.61 Typical High $8,128.31 | Professional | None | $4,466.84 | $5,128.61 | $8,128.31 |
UPMC Health Plan Setting Facility Modifier None Typical Low $3,801.89 Median $4,365.16 Typical High $4,365.16 | Facility | None | $3,801.89 | $4,365.16 | $4,365.16 |
UPMC Health Plan Setting Professional Modifier None Typical Low $3,801.89 Median $4,365.16 Typical High $4,365.16 | Professional | None | $3,801.89 | $4,365.16 | $4,365.16 |
United Setting Facility Modifier None Typical Low $2,818.38 Median $5,495.41 Typical High $15,848.93 | Facility | None | $2,818.38 | $5,495.41 | $15,848.93 |
United Setting Professional Modifier None Typical Low $3,715.35 Median $4,365.16 Typical High $6,456.54 | Professional | None | $3,715.35 | $4,365.16 | $6,456.54 |
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 $1,778.28 Median $1,905.46 Typical High $2,041.74 | Professional | 52 · Reduced service | $1,778.28 | $1,905.46 | $2,041.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $707.95 Median $776.25 Typical High $812.83 | Professional | 53 · Discontinued | $707.95 | $776.25 | $812.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,630.27 Median $2,884.03 Typical High $3,019.95 | Professional | 54 · Surgery only | $2,630.27 | $2,884.03 | $3,019.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $537.03 Median $575.44 Typical High $616.60 | Professional | 55 · Aftercare only | $537.03 | $575.44 | $616.60 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $354.81 Median $389.05 Typical High $407.38 | Professional | 56 · Pre-op care only | $354.81 | $389.05 | $407.38 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $5,888.44 Median $6,165.95 Typical High $11,481.54 | Professional | 50 · Both sides | $5,888.44 | $6,165.95 | $11,481.54 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,778.28 Median $1,905.46 Typical High $2,041.74 | Professional | 52 · Reduced service | $1,778.28 | $1,905.46 | $2,041.74 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $707.95 Median $758.58 Typical High $812.83 | Professional | 53 · Discontinued | $707.95 | $758.58 | $812.83 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,630.27 Median $2,818.38 Typical High $3,019.95 | Professional | 54 · Surgery only | $2,630.27 | $2,818.38 | $3,019.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $537.03 Median $562.34 Typical High $616.60 | Professional | 55 · Aftercare only | $537.03 | $562.34 | $616.60 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $354.81 Median $380.19 Typical High $407.38 | Professional | 56 · Pre-op care only | $354.81 | $380.19 | $407.38 |
Where Pennsylvania sits
The same service costs 20.4 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
$4,074
AK $15,849TX $776
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.