How much rates vary
Facilitymedian $2,455 · 10th to 90th $676 to $7,244Professionalmedian $871 · 10th to 90th $776 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 $794.33 Median $4,897.79 Typical High $8,511.38 | Facility | None | $794.33 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $776.25 Median $831.76 Typical High $891.25 | Professional | None | $776.25 | $831.76 | $891.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $588.84 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $537.03 | $588.84 | $616.60 |
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 $831.76 Median $851.14 Typical High $1,698.24 | Professional | None | $831.76 | $851.14 | $1,698.24 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $575.44 Median $588.84 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $575.44 | $588.84 | $1,174.90 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $1,659.59 Typical High $2,691.53 | Facility | None | $549.54 | $1,659.59 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $812.83 Median $851.14 Typical High $1,862.09 | Professional | None | $812.83 | $851.14 | $1,862.09 |
Emblem Health Setting Professional Modifier None Typical Low $977.24 Median $1,318.26 Typical High $1,318.26 | Professional | None | $977.24 | $1,318.26 | $1,318.26 |
Geisinger Setting Professional Modifier None Typical Low $776.25 Median $1,023.29 Typical High $1,862.09 | Professional | None | $776.25 | $1,023.29 | $1,862.09 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $4,897.79 Typical High $8,709.64 | Facility | None | $831.76 | $4,897.79 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $776.25 Median $812.83 Typical High $891.25 | Professional | None | $776.25 | $812.83 | $891.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $562.34 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $537.03 | $562.34 | $616.60 |
Oscar Health Setting Professional Modifier None Typical Low $954.99 Median $1,174.90 Typical High $1,778.28 | Professional | None | $954.99 | $1,174.90 | $1,778.28 |
UPMC Health Plan Setting Facility Modifier None Typical Low $831.76 Median $1,000.00 Typical High $1,000.00 | Facility | None | $831.76 | $1,000.00 | $1,000.00 |
UPMC Health Plan Setting Professional Modifier None Typical Low $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | None | $831.76 | $1,000.00 | $1,000.00 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,235.94 Typical High $7,079.46 | Facility | None | $1,698.24 | $3,235.94 | $7,079.46 |
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 $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 $660.69 | Professional | 54 · Surgery only | $575.44 | $630.96 | $660.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $125.89 Typical High $131.83 | Professional | 55 · Aftercare only | $114.82 | $125.89 | $131.83 |
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 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,230.27 Median $1,288.25 Typical High $2,511.89 | Professional | 50 · Both sides | $1,230.27 | $1,288.25 | $2,511.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $389.05 Median $398.11 Typical High $446.68 | Professional | 52 · Reduced service | $389.05 | $398.11 | $446.68 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $158.49 Typical High $177.83 | Professional | 53 · Discontinued | $154.88 | $158.49 | $177.83 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $575.44 Median $602.56 Typical High $660.69 | Professional | 54 · Surgery only | $575.44 | $602.56 | $660.69 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $120.23 Typical High $131.83 | Professional | 55 · Aftercare only | $114.82 | $120.23 | $131.83 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $77.62 Median $79.43 Typical High $89.13 | Professional | 56 · Pre-op care only | $77.62 | $79.43 | $89.13 |
Where Pennsylvania sits
The same service costs 5.0 times more in Alabama than in Kentucky. 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.
Physician feeFacility fee
AL $11,256KY $2,261
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.