How much rates vary
Facilitymedian $5,012 · 10th to 90th $676 to $14,791Professionalmedian $1,660 · 10th to 90th $1,445 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 $831.76 Median $4,897.79 Typical High $8,511.38 | Facility | None | $831.76 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,445.44 Median $1,584.89 Typical High $1,698.24 | Professional | None | $1,445.44 | $1,584.89 | $1,698.24 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $1,122.02 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,023.29 | $1,122.02 | $1,174.90 |
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 $2,398.83 Median $2,570.40 Typical High $56,234.13 | Professional | None | $2,398.83 | $2,570.40 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,174.90 Typical High $2,137.96 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,174.90 | $2,137.96 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $8,511.38 Typical High $15,135.61 | Facility | None | $549.54 | $8,511.38 | $15,135.61 |
Cigna Setting Professional Modifier None Typical Low $1,479.11 Median $1,621.81 Typical High $3,548.13 | Professional | None | $1,479.11 | $1,621.81 | $3,548.13 |
Emblem Health Setting Professional Modifier None Typical Low $1,862.09 Median $2,570.40 Typical High $2,570.40 | Professional | None | $1,862.09 | $2,570.40 | $2,570.40 |
Geisinger Setting Professional Modifier None Typical Low $1,479.11 Median $1,905.46 Typical High $3,388.44 | Professional | None | $1,479.11 | $1,905.46 | $3,388.44 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $3,801.89 Typical High $8,709.64 | Facility | None | $831.76 | $3,801.89 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,445.44 Median $1,584.89 Typical High $1,698.24 | Professional | None | $1,445.44 | $1,584.89 | $1,698.24 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $1,096.48 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,023.29 | $1,096.48 | $1,174.90 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $1,995.26 Typical High $3,090.30 | Professional | None | $15.14 | $1,995.26 | $3,090.30 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,584.89 Median $2,187.76 Typical High $2,187.76 | Facility | None | $1,584.89 | $2,187.76 | $2,187.76 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,584.89 Median $2,187.76 Typical High $2,187.76 | Professional | None | $1,584.89 | $2,187.76 | $2,187.76 |
United Setting Facility Modifier None Typical Low $2,818.38 Median $5,495.41 Typical High $14,454.40 | Facility | None | $2,818.38 | $5,495.41 | $14,454.40 |
United Setting Professional Modifier None Typical Low $1,513.56 Median $1,778.28 Typical High $2,691.53 | Professional | None | $1,513.56 | $1,778.28 | $2,691.53 |
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 $724.44 Median $794.33 Typical High $851.14 | Professional | 52 · Reduced service | $724.44 | $794.33 | $851.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $316.23 Typical High $338.84 | Professional | 53 · Discontinued | $295.12 | $316.23 | $338.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,202.26 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,096.48 | $1,202.26 | $1,258.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $218.78 Median $239.88 Typical High $251.19 | Professional | 55 · Aftercare only | $218.78 | $239.88 | $251.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $144.54 Median $158.49 Typical High $169.82 | Professional | 56 · Pre-op care only | $144.54 | $158.49 | $169.82 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $724.44 Median $794.33 Typical High $851.14 | Professional | 52 · Reduced service | $724.44 | $794.33 | $851.14 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $316.23 Typical High $338.84 | Professional | 53 · Discontinued | $295.12 | $316.23 | $338.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,174.90 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,096.48 | $1,174.90 | $1,258.93 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $218.78 Median $234.42 Typical High $251.19 | Professional | 55 · Aftercare only | $218.78 | $234.42 | $251.19 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $144.54 Median $158.49 Typical High $169.82 | Professional | 56 · Pre-op care only | $144.54 | $158.49 | $169.82 |
Where Pennsylvania sits
The same service costs 20.4 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
$1,660
AK $6,607TX $324
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.