How much rates vary
Facilitymedian $3,090 · 10th to 90th $741 to $8,710Professionalmedian $1,380 · 10th to 90th $1,202 to $2,344
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 $1,202.26 Median $1,288.25 Typical High $1,380.38 | Professional | None | $1,202.26 | $1,288.25 | $1,380.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $831.76 Median $912.01 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $831.76 | $912.01 | $954.99 |
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 $1,318.26 Median $1,380.38 Typical High $2,570.40 | Professional | None | $1,318.26 | $1,380.38 | $2,570.40 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $954.99 Typical High $1,778.28 | Professional | 78 · Unplanned return to OR | $912.01 | $954.99 | $1,778.28 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $2,818.38 Typical High $4,897.79 | Facility | None | $549.54 | $2,818.38 | $4,897.79 |
Cigna Setting Professional Modifier None Typical Low $1,258.93 Median $1,348.96 Typical High $2,884.03 | Professional | None | $1,258.93 | $1,348.96 | $2,884.03 |
Emblem Health Setting Professional Modifier None Typical Low $1,548.82 Median $2,041.74 Typical High $2,041.74 | Professional | None | $1,548.82 | $2,041.74 | $2,041.74 |
Geisinger Setting Professional Modifier None Typical Low $1,174.90 Median $1,584.89 Typical High $2,818.38 | Professional | None | $1,174.90 | $1,584.89 | $2,818.38 |
Highmark BCBS Setting Facility Modifier None Typical Low $12,882.50 Median $23,442.29 Typical High $38,018.94 | Facility | None | $12,882.50 | $23,442.29 | $38,018.94 |
Martin's Point Setting Facility Modifier None Typical Low $1,023.29 Median $4,570.88 Typical High $8,709.64 | Facility | None | $1,023.29 | $4,570.88 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,202.26 Median $1,288.25 Typical High $1,380.38 | Professional | None | $1,202.26 | $1,288.25 | $1,380.38 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $831.76 Median $891.25 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $831.76 | $891.25 | $954.99 |
Oscar Health Setting Professional Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $2,691.53 | Professional | None | $1,412.54 | $1,412.54 | $2,691.53 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,288.25 Median $6,165.95 Typical High $10,000.00 | Facility | None | $1,288.25 | $6,165.95 | $10,000.00 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,288.25 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,288.25 | $1,412.54 | $1,412.54 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,398.83 Typical High $6,918.31 | Facility | None | $1,380.38 | $2,398.83 | $6,918.31 |
United Setting Professional Modifier None Typical Low $1,230.27 Median $1,445.44 Typical High $2,187.76 | Professional | None | $1,230.27 | $1,445.44 | $2,187.76 |
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 $602.56 Median $645.65 Typical High $691.83 | Professional | 52 · Reduced service | $602.56 | $645.65 | $691.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $263.03 Typical High $275.42 | Professional | 53 · Discontinued | $239.88 | $263.03 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $891.25 Median $977.24 Typical High $1,023.29 | Professional | 54 · Surgery only | $891.25 | $977.24 | $1,023.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $177.83 Median $194.98 Typical High $204.17 | Professional | 55 · Aftercare only | $177.83 | $194.98 | $204.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $128.82 Typical High $138.04 | Professional | 56 · Pre-op care only | $120.23 | $128.82 | $138.04 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $602.56 Median $630.96 Typical High $691.83 | Professional | 52 · Reduced service | $602.56 | $630.96 | $691.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $257.04 Typical High $275.42 | Professional | 53 · Discontinued | $239.88 | $257.04 | $275.42 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $891.25 Median $954.99 Typical High $1,023.29 | Professional | 54 · Surgery only | $891.25 | $954.99 | $1,023.29 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $177.83 Median $190.55 Typical High $204.17 | Professional | 55 · Aftercare only | $177.83 | $190.55 | $204.17 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $125.89 Typical High $138.04 | Professional | 56 · Pre-op care only | $120.23 | $125.89 | $138.04 |
Where Pennsylvania sits
The same service costs 15.1 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· 40th of 51
$1,380
AK $5,370TX $355
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.