How much rates vary
Facilitymedian $1,660 · 10th to 90th $537 to $6,166Professionalmedian $871 · 10th to 90th $759 to $1,202
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 $891.25 Median $5,011.87 Typical High $8,511.38 | Facility | None | $891.25 | $5,011.87 | $8,511.38 |
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 $537.03 Median $588.84 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $537.03 | $588.84 | $630.96 |
Ambetter Setting Professional Modifier None Typical Low $794.33 Median $794.33 Typical High $794.33 | Professional | None | $794.33 | $794.33 | $794.33 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $56,234.13 | Facility | None | $3,981.07 | $4,365.16 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,258.93 Median $1,380.38 Typical High $56,234.13 | Professional | None | $1,258.93 | $1,380.38 | $56,234.13 |
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 $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 $758.58 Median $870.96 Typical High $1,862.09 | Professional | None | $758.58 | $870.96 | $1,862.09 |
Emblem Health Setting Professional Modifier None Typical Low $1,047.13 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,047.13 | $1,412.54 | $1,412.54 |
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 $758.58 Median $1,023.29 Typical High $1,737.80 | Professional | None | $758.58 | $1,023.29 | $1,737.80 |
Martin's Point Setting Facility Modifier None Typical Low $891.25 Median $4,786.30 Typical High $8,511.38 | Facility | None | $891.25 | $4,786.30 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $776.25 Median $831.76 Typical High $891.25 | Professional | None | $776.25 | $831.76 | $891.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $575.44 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $537.03 | $575.44 | $630.96 |
Oscar Health Setting Professional Modifier None Typical Low $1,000.00 Median $1,047.13 Typical High $1,621.81 | Professional | None | $1,000.00 | $1,047.13 | $1,621.81 |
UPMC Health Plan Setting Facility Modifier None Typical Low $851.14 Median $2,137.96 Typical High $4,265.80 | Facility | None | $851.14 | $2,137.96 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $851.14 Median $912.01 Typical High $912.01 | Professional | None | $851.14 | $912.01 | $912.01 |
United Setting Facility Modifier None Typical Low $416.87 Median $724.44 Typical High $4,265.80 | Facility | None | $416.87 | $724.44 | $4,265.80 |
United Setting Professional Modifier None Typical Low $776.25 Median $933.25 Typical High $1,412.54 | Professional | None | $776.25 | $933.25 | $1,412.54 |
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 $389.05 Median $416.87 Typical High $446.68 | Professional | 52 · Reduced service | $389.05 | $416.87 | $446.68 |
Aetna 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 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $575.44 Median $630.96 Typical High $676.08 | Professional | 54 · Surgery only | $575.44 | $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 $83.18 Typical High $89.13 | Professional | 56 · Pre-op care only | $77.62 | $83.18 | $89.13 |
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 $575.44 Median $616.60 Typical High $676.08 | Professional | 54 · Surgery only | $575.44 | $616.60 | $676.08 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $117.49 Median $123.03 Typical High $134.90 | Professional | 55 · Aftercare only | $117.49 | $123.03 | $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 7.1 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· 42nd of 51
$871
AK $3,548TX $501
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.