How much rates vary
Facilitymedian $2,344 · 10th to 90th $871 to $6,457Professionalmedian $1,000 · 10th to 90th $891 to $1,738
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 $977.24 Median $4,897.79 Typical High $8,511.38 | Facility | None | $977.24 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $870.96 Median $933.25 Typical High $1,000.00 | Professional | None | $870.96 | $933.25 | $1,000.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $602.56 Median $645.65 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $602.56 | $645.65 | $691.83 |
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 $954.99 Median $1,000.00 Typical High $1,819.70 | Professional | None | $954.99 | $1,000.00 | $1,819.70 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $691.83 Typical High $1,258.93 | Professional | 78 · Unplanned return to OR | $660.69 | $691.83 | $1,258.93 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,584.89 Typical High $2,818.38 | Facility | None | $616.60 | $1,584.89 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $933.25 Median $1,047.13 Typical High $2,089.30 | Professional | None | $933.25 | $1,047.13 | $2,089.30 |
Emblem Health Setting Professional Modifier None Typical Low $1,122.02 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,122.02 | $1,548.82 | $1,548.82 |
Geisinger Setting Facility Modifier None Typical Low $1,584.89 Median $1,995.26 Typical High $3,467.37 | Facility | None | $1,584.89 | $1,995.26 | $3,467.37 |
Geisinger Setting Professional Modifier None Typical Low $891.25 Median $1,258.93 Typical High $2,398.83 | Professional | None | $891.25 | $1,258.93 | $2,398.83 |
Martin's Point Setting Facility Modifier None Typical Low $1,000.00 Median $4,570.88 Typical High $8,511.38 | Facility | None | $1,000.00 | $4,570.88 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $870.96 Median $912.01 Typical High $1,000.00 | Professional | None | $870.96 | $912.01 | $1,000.00 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $602.56 Median $645.65 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $602.56 | $645.65 | $691.83 |
Oscar Health Setting Professional Modifier None Typical Low $1,096.48 Median $1,412.54 Typical High $2,041.74 | Professional | None | $1,096.48 | $1,412.54 | $2,041.74 |
UPMC Health Plan Setting Facility Modifier None Typical Low $933.25 Median $2,137.96 Typical High $4,265.80 | Facility | None | $933.25 | $2,137.96 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $933.25 Median $1,122.02 Typical High $1,122.02 | Professional | None | $933.25 | $1,122.02 | $1,122.02 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,398.83 Typical High $6,309.57 | Facility | None | $1,380.38 | $2,398.83 | $6,309.57 |
United Setting Professional Modifier None Typical Low $912.01 Median $1,047.13 Typical High $1,584.89 | Professional | None | $912.01 | $1,047.13 | $1,584.89 |
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 $426.58 Median $457.09 Typical High $501.19 | Professional | 52 · Reduced service | $426.58 | $457.09 | $501.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $173.78 Median $181.97 Typical High $199.53 | Professional | 53 · Discontinued | $173.78 | $181.97 | $199.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $645.65 Median $691.83 Typical High $741.31 | Professional | 54 · Surgery only | $645.65 | $691.83 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $128.82 Median $138.04 Typical High $147.91 | Professional | 55 · Aftercare only | $128.82 | $138.04 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $87.10 Median $91.20 Typical High $100.00 | Professional | 56 · Pre-op care only | $87.10 | $91.20 | $100.00 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,445.44 Median $1,479.11 Typical High $2,754.23 | Professional | 50 · Both sides | $1,445.44 | $1,479.11 | $2,754.23 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $426.58 Median $457.09 Typical High $501.19 | Professional | 52 · Reduced service | $426.58 | $457.09 | $501.19 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $173.78 Median $181.97 Typical High $199.53 | Professional | 53 · Discontinued | $173.78 | $181.97 | $199.53 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $645.65 Median $691.83 Typical High $741.31 | Professional | 54 · Surgery only | $645.65 | $691.83 | $741.31 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $128.82 Median $138.04 Typical High $147.91 | Professional | 55 · Aftercare only | $128.82 | $138.04 | $147.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $87.10 Median $91.20 Typical High $100.00 | Professional | 56 · Pre-op care only | $87.10 | $91.20 | $100.00 |
Where Pennsylvania sits
The same service costs 16.2 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
$1,000
AK $3,890TX $240
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.