How much rates vary
Facilitymedian $2,570 · 10th to 90th $631 to $8,128Professionalmedian $2,188 · 10th to 90th $1,820 to $3,020
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 $2,041.74 Median $2,089.30 Typical High $2,344.23 | Professional | None | $2,041.74 | $2,089.30 | $2,344.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,412.54 Median $1,445.44 Typical High $1,621.81 | Professional | 78 · Unplanned return to OR | $1,412.54 | $1,445.44 | $1,621.81 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $12,022.64 Typical High $56,234.13 | Facility | None | $3,981.07 | $12,022.64 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $3,311.31 Median $3,548.13 Typical High $56,234.13 | Professional | None | $3,311.31 | $3,548.13 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,548.82 Median $1,584.89 Typical High $2,754.23 | Professional | 78 · Unplanned return to OR | $1,548.82 | $1,584.89 | $2,754.23 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $2,691.53 Typical High $4,897.79 | Facility | None | $501.19 | $2,691.53 | $4,897.79 |
Cigna Setting Professional Modifier None Typical Low $1,778.28 Median $2,137.96 Typical High $4,677.35 | Professional | None | $1,778.28 | $2,137.96 | $4,677.35 |
Emblem Health Setting Professional Modifier None Typical Low $2,570.40 Median $3,467.37 Typical High $3,467.37 | Professional | None | $2,570.40 | $3,467.37 | $3,467.37 |
Geisinger Setting Professional Modifier None Typical Low $1,905.46 Median $2,511.89 Typical High $4,265.80 | Professional | None | $1,905.46 | $2,511.89 | $4,265.80 |
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 $2,041.74 Median $2,089.30 Typical High $2,344.23 | Professional | None | $2,041.74 | $2,089.30 | $2,344.23 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,412.54 Median $1,445.44 Typical High $1,621.81 | Professional | 78 · Unplanned return to OR | $1,412.54 | $1,445.44 | $1,621.81 |
Oscar Health Setting Professional Modifier None Typical Low $2,238.72 Median $2,238.72 Typical High $3,981.07 | Professional | None | $2,238.72 | $2,238.72 | $3,981.07 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $2,187.76 | Facility | None | $1,949.84 | $1,949.84 | $2,187.76 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $2,187.76 | Professional | None | $1,949.84 | $1,949.84 | $2,187.76 |
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 $1,905.46 Median $2,398.83 Typical High $3,630.78 | Professional | None | $1,905.46 | $2,398.83 | $3,630.78 |
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 $1,000.00 Median $1,047.13 Typical High $1,174.90 | Professional | 52 · Reduced service | $1,000.00 | $1,047.13 | $1,174.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $407.38 Median $416.87 Typical High $467.74 | Professional | 53 · Discontinued | $407.38 | $416.87 | $467.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,513.56 Median $1,548.82 Typical High $1,737.80 | Professional | 54 · Surgery only | $1,513.56 | $1,548.82 | $1,737.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $302.00 Median $316.23 Typical High $346.74 | Professional | 55 · Aftercare only | $302.00 | $316.23 | $346.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $204.17 Median $208.93 Typical High $234.42 | Professional | 56 · Pre-op care only | $204.17 | $208.93 | $234.42 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,000.00 Median $1,047.13 Typical High $1,174.90 | Professional | 52 · Reduced service | $1,000.00 | $1,047.13 | $1,174.90 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $407.38 Median $416.87 Typical High $467.74 | Professional | 53 · Discontinued | $407.38 | $416.87 | $467.74 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,513.56 Median $1,548.82 Typical High $1,737.80 | Professional | 54 · Surgery only | $1,513.56 | $1,548.82 | $1,737.80 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $302.00 Median $316.23 Typical High $346.74 | Professional | 55 · Aftercare only | $302.00 | $316.23 | $346.74 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $204.17 Median $208.93 Typical High $234.42 | Professional | 56 · Pre-op care only | $204.17 | $208.93 | $234.42 |
Where Pennsylvania sits
The same service costs 21.4 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· 44th of 51
$2,188
AK $9,120TX $427
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.