How much rates vary
Facilitymedian $3,631 · 10th to 90th $741 to $7,943Professionalmedian $891 · 10th to 90th $776 to $1,549
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 $3,801.89 Typical High $8,317.64 | Facility | None | $831.76 | $3,801.89 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $776.25 Median $851.14 Typical High $891.25 | Professional | None | $776.25 | $851.14 | $891.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $588.84 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $549.54 | $588.84 | $630.96 |
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 $870.96 Median $891.25 Typical High $1,621.81 | Professional | None | $870.96 | $891.25 | $1,621.81 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $602.56 Median $616.60 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $602.56 | $616.60 | $1,122.02 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $2,691.53 Typical High $5,888.44 | Facility | None | $501.19 | $2,691.53 | $5,888.44 |
Cigna Setting Professional Modifier None Typical Low $776.25 Median $870.96 Typical High $1,862.09 | Professional | None | $776.25 | $870.96 | $1,862.09 |
Emblem Health Setting Professional Modifier None Typical Low $1,023.29 Median $1,380.38 Typical High $1,380.38 | Professional | None | $1,023.29 | $1,380.38 | $1,380.38 |
Geisinger Setting Facility Modifier None Typical Low $3,630.78 Median $4,466.84 Typical High $7,943.28 | Facility | None | $3,630.78 | $4,466.84 | $7,943.28 |
Geisinger Setting Professional Modifier None Typical Low $794.33 Median $1,023.29 Typical High $1,778.28 | Professional | None | $794.33 | $1,023.29 | $1,778.28 |
Martin's Point Setting Facility Modifier None Typical Low $891.25 Median $3,715.35 Typical High $8,317.64 | Facility | None | $891.25 | $3,715.35 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $776.25 Median $851.14 Typical High $891.25 | Professional | None | $776.25 | $851.14 | $891.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $588.84 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $549.54 | $588.84 | $630.96 |
Oscar Health Setting Professional Modifier None Typical Low $1,000.00 Median $1,047.13 Typical High $1,659.59 | Professional | None | $1,000.00 | $1,047.13 | $1,659.59 |
UPMC Health Plan Setting Facility Modifier None Typical Low $851.14 Median $1,737.80 Typical High $3,388.44 | Facility | None | $851.14 | $1,737.80 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $851.14 Median $954.99 Typical High $954.99 | Professional | None | $851.14 | $954.99 | $954.99 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,235.94 Typical High $10,000.00 | Facility | None | $1,698.24 | $3,235.94 | $10,000.00 |
United Setting Professional Modifier None Typical Low $794.33 Median $933.25 Typical High $1,412.54 | Professional | None | $794.33 | $933.25 | $1,412.54 |
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 $389.05 Median $426.58 Typical High $446.68 | Professional | 52 · Reduced service | $389.05 | $426.58 | $446.68 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $169.82 Typical High $177.83 | Professional | 53 · Discontinued | $154.88 | $169.82 | $177.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $630.96 Typical High $676.08 | Professional | 54 · Surgery only | $588.84 | $630.96 | $676.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $117.49 Median $125.89 Typical High $134.90 | Professional | 55 · Aftercare only | $117.49 | $125.89 | $134.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $77.62 Median $85.11 Typical High $89.13 | Professional | 56 · Pre-op care only | $77.62 | $85.11 | $89.13 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,288.25 Median $1,348.96 Typical High $2,454.71 | Professional | 50 · Both sides | $1,288.25 | $1,348.96 | $2,454.71 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $389.05 Median $416.87 Typical High $446.68 | Professional | 52 · Reduced service | $389.05 | $416.87 | $446.68 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $165.96 Typical High $177.83 | Professional | 53 · Discontinued | $154.88 | $165.96 | $177.83 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $630.96 Typical High $676.08 | Professional | 54 · Surgery only | $588.84 | $630.96 | $676.08 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $117.49 Median $125.89 Typical High $134.90 | Professional | 55 · Aftercare only | $117.49 | $125.89 | $134.90 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $77.62 Median $83.18 Typical High $89.13 | Professional | 56 · Pre-op care only | $77.62 | $83.18 | $89.13 |
Where Pennsylvania sits
The same service costs 8.1 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
$891
AK $3,548TX $437
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.