How much rates vary
Facilitymedian $3,311 · 10th to 90th $724 to $7,943Professionalmedian $891 · 10th to 90th $794 to $1,514
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 $4,073.80 Typical High $8,317.64 | Facility | None | $831.76 | $4,073.80 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $794.33 Median $851.14 Typical High $933.25 | Professional | None | $794.33 | $851.14 | $933.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $588.84 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $562.34 | $588.84 | $660.69 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $56,234.13 | Facility | None | $3,981.07 | $7,413.10 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $870.96 Median $891.25 Typical High $1,548.82 | Professional | None | $870.96 | $891.25 | $1,548.82 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $602.56 Median $616.60 Typical High $1,071.52 | Professional | 78 · Unplanned return to OR | $602.56 | $616.60 | $1,071.52 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $2,691.53 Typical High $7,585.78 | Facility | None | $501.19 | $2,691.53 | $7,585.78 |
Cigna Setting Professional Modifier None Typical Low $812.83 Median $851.14 Typical High $1,905.46 | Professional | None | $812.83 | $851.14 | $1,905.46 |
Emblem Health Setting Professional Modifier None Typical Low $1,096.48 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,096.48 | $1,479.11 | $1,479.11 |
Geisinger Setting Facility Modifier None Typical Low $4,570.88 Median $5,623.41 Typical High $10,000.00 | Facility | None | $4,570.88 | $5,623.41 | $10,000.00 |
Geisinger Setting Professional Modifier None Typical Low $812.83 Median $1,096.48 Typical High $1,862.09 | Professional | None | $812.83 | $1,096.48 | $1,862.09 |
Martin's Point Setting Facility Modifier None Typical Low $933.25 Median $3,801.89 Typical High $8,317.64 | Facility | None | $933.25 | $3,801.89 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $794.33 Median $851.14 Typical High $933.25 | Professional | None | $794.33 | $851.14 | $933.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $588.84 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $562.34 | $588.84 | $660.69 |
Oscar Health Setting Professional Modifier None Typical Low $977.24 Median $977.24 Typical High $1,659.59 | Professional | None | $977.24 | $977.24 | $1,659.59 |
UPMC Health Plan Setting Facility Modifier None Typical Low $870.96 Median $1,737.80 Typical High $3,467.37 | Facility | None | $870.96 | $1,737.80 | $3,467.37 |
UPMC Health Plan Setting Professional Modifier None Typical Low $870.96 Median $912.01 Typical High $912.01 | Professional | None | $870.96 | $912.01 | $912.01 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,905.46 Typical High $6,025.60 | Facility | None | $1,148.15 | $1,905.46 | $6,025.60 |
United Setting Professional Modifier None Typical Low $758.58 Median $912.01 Typical High $1,380.38 | Professional | None | $758.58 | $912.01 | $1,380.38 |
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 $398.11 Median $426.58 Typical High $467.74 | Professional | 52 · Reduced service | $398.11 | $426.58 | $467.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $169.82 Typical High $186.21 | Professional | 53 · Discontinued | $158.49 | $169.82 | $186.21 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $630.96 Typical High $707.95 | Professional | 54 · Surgery only | $602.56 | $630.96 | $707.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $125.89 Typical High $141.25 | Professional | 55 · Aftercare only | $120.23 | $125.89 | $141.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $85.11 Typical High $93.33 | Professional | 56 · Pre-op care only | $79.43 | $85.11 | $93.33 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,288.25 Median $1,348.96 Typical High $2,344.23 | Professional | 50 · Both sides | $1,288.25 | $1,348.96 | $2,344.23 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $398.11 Median $416.87 Typical High $467.74 | Professional | 52 · Reduced service | $398.11 | $416.87 | $467.74 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $169.82 Typical High $186.21 | Professional | 53 · Discontinued | $158.49 | $169.82 | $186.21 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $630.96 Typical High $707.95 | Professional | 54 · Surgery only | $602.56 | $630.96 | $707.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $125.89 Typical High $141.25 | Professional | 55 · Aftercare only | $120.23 | $125.89 | $141.25 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $85.11 Typical High $93.33 | Professional | 56 · Pre-op care only | $79.43 | $85.11 | $93.33 |
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· 42nd of 51
$891
AK $3,631TX $447
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.