How much rates vary
Facilitymedian $2,884 · 10th to 90th $708 to $8,511Professionalmedian $1,288 · 10th to 90th $1,148 to $2,239
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 $1,047.13 Median $5,495.41 Typical High $8,709.64 | Facility | None | $1,047.13 | $5,495.41 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $1,148.15 Median $1,230.27 Typical High $1,318.26 | Professional | None | $1,148.15 | $1,230.27 | $1,318.26 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $851.14 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $794.33 | $851.14 | $933.25 |
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 $1,288.25 Median $1,318.26 Typical High $2,290.87 | Professional | None | $1,288.25 | $1,318.26 | $2,290.87 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $912.01 Typical High $1,584.89 | Professional | 78 · Unplanned return to OR | $870.96 | $912.01 | $1,584.89 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $3,548.13 Typical High $6,165.95 | Facility | None | $549.54 | $3,548.13 | $6,165.95 |
Cigna Setting Professional Modifier None Typical Low $1,148.15 Median $1,230.27 Typical High $2,754.23 | Professional | None | $1,148.15 | $1,230.27 | $2,754.23 |
Emblem Health Setting Professional Modifier None Typical Low $1,479.11 Median $1,949.84 Typical High $1,949.84 | Professional | None | $1,479.11 | $1,949.84 | $1,949.84 |
Geisinger Setting Professional Modifier None Typical Low $1,148.15 Median $1,479.11 Typical High $2,570.40 | Professional | None | $1,148.15 | $1,479.11 | $2,570.40 |
Martin's Point Setting Facility Modifier None Typical Low $1,148.15 Median $5,248.07 Typical High $8,709.64 | Facility | None | $1,148.15 | $5,248.07 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,148.15 Median $1,230.27 Typical High $1,318.26 | Professional | None | $1,148.15 | $1,230.27 | $1,318.26 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $851.14 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $794.33 | $851.14 | $933.25 |
Oscar Health Setting Professional Modifier None Typical Low $1,380.38 Median $1,380.38 Typical High $2,398.83 | Professional | None | $1,380.38 | $1,380.38 | $2,398.83 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,258.93 | Facility | None | $1,230.27 | $1,230.27 | $1,258.93 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,258.93 | Professional | None | $1,230.27 | $1,230.27 | $1,258.93 |
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 $1,148.15 Median $1,412.54 Typical High $2,089.30 | Professional | None | $1,148.15 | $1,412.54 | $2,089.30 |
12 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 $575.44 Median $616.60 Typical High $660.69 | Professional | 52 · Reduced service | $575.44 | $616.60 | $660.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $245.47 Typical High $263.03 | Professional | 53 · Discontinued | $229.09 | $245.47 | $263.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $912.01 Typical High $1,000.00 | Professional | 54 · Surgery only | $851.14 | $912.01 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $173.78 Median $186.21 Typical High $199.53 | Professional | 55 · Aftercare only | $173.78 | $186.21 | $199.53 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $123.03 Typical High $131.83 | Professional | 56 · Pre-op care only | $114.82 | $123.03 | $131.83 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,905.46 Median $1,995.26 Typical High $3,467.37 | Professional | 50 · Both sides | $1,905.46 | $1,995.26 | $3,467.37 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $575.44 Median $616.60 Typical High $660.69 | Professional | 52 · Reduced service | $575.44 | $616.60 | $660.69 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $245.47 Typical High $263.03 | Professional | 53 · Discontinued | $229.09 | $245.47 | $263.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $912.01 Typical High $1,000.00 | Professional | 54 · Surgery only | $851.14 | $912.01 | $1,000.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $173.78 Median $186.21 Typical High $199.53 | Professional | 55 · Aftercare only | $173.78 | $186.21 | $199.53 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $123.03 Typical High $131.83 | Professional | 56 · Pre-op care only | $114.82 | $123.03 | $131.83 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $1,202.26 Median $1,202.26 Typical High $1,202.26 | Professional | 62 · Two surgeons | $1,202.26 | $1,202.26 | $1,202.26 |
Where Pennsylvania sits
The same service costs 17.8 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· 41st of 51
$1,318
AK $5,129TX $288
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.