How much rates vary
Facilitymedian $3,020 · 10th to 90th $813 to $7,413Professionalmedian $851 · 10th to 90th $724 to $1,479
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 $912.01 Median $4,897.79 Typical High $8,511.38 | Facility | None | $912.01 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $812.83 Median $870.96 Typical High $912.01 | Professional | None | $812.83 | $870.96 | $912.01 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $602.56 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $562.34 | $602.56 | $630.96 |
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 $812.83 Median $1,258.93 Typical High $1,513.56 | Professional | None | $812.83 | $1,258.93 | $1,513.56 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $616.60 Median $954.99 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $616.60 | $954.99 | $1,174.90 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $2,818.38 Typical High $4,897.79 | Facility | None | $616.60 | $2,818.38 | $4,897.79 |
Cigna Setting Professional Modifier None Typical Low $724.44 Median $794.33 Typical High $1,513.56 | Professional | None | $724.44 | $794.33 | $1,513.56 |
Emblem Health Setting Professional Modifier None Typical Low $1,202.26 Median $1,202.26 Typical High $1,288.25 | Professional | None | $1,202.26 | $1,202.26 | $1,288.25 |
Geisinger Setting Facility Modifier None Typical Low $2,951.21 Median $3,630.78 Typical High $6,456.54 | Facility | None | $2,951.21 | $3,630.78 | $6,456.54 |
Geisinger Setting Professional Modifier None Typical Low $707.95 Median $954.99 Typical High $1,584.89 | Professional | None | $707.95 | $954.99 | $1,584.89 |
Martin's Point Setting Facility Modifier None Typical Low $912.01 Median $4,570.88 Typical High $8,511.38 | Facility | None | $912.01 | $4,570.88 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $812.83 Median $870.96 Typical High $912.01 | Professional | None | $812.83 | $870.96 | $912.01 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $602.56 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $562.34 | $602.56 | $630.96 |
Oscar Health Setting Professional Modifier None Typical Low $831.76 Median $933.25 Typical High $1,548.82 | Professional | None | $831.76 | $933.25 | $1,548.82 |
UPMC Health Plan Setting Facility Modifier None Typical Low $812.83 Median $2,137.96 Typical High $4,168.69 | Facility | None | $812.83 | $2,137.96 | $4,168.69 |
UPMC Health Plan Setting Professional Modifier None Typical Low $812.83 Median $812.83 Typical High $812.83 | Professional | None | $812.83 | $812.83 | $812.83 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,398.83 Typical High $6,918.31 | Facility | None | $1,380.38 | $2,398.83 | $6,918.31 |
United Setting Professional Modifier None Typical Low $645.65 Median $831.76 Typical High $1,621.81 | Professional | None | $645.65 | $831.76 | $1,621.81 |
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 $446.68 | Professional | 52 · Reduced service | $398.11 | $426.58 | $446.68 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $162.18 Median $173.78 Typical High $181.97 | Professional | 53 · Discontinued | $162.18 | $173.78 | $181.97 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $645.65 Typical High $676.08 | Professional | 54 · Surgery only | $602.56 | $645.65 | $676.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $128.82 Typical High $134.90 | Professional | 55 · Aftercare only | $120.23 | $128.82 | $134.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $87.10 Typical High $91.20 | Professional | 56 · Pre-op care only | $81.28 | $87.10 | $91.20 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,230.27 Median $1,905.46 Typical High $2,290.87 | Professional | 50 · Both sides | $1,230.27 | $1,905.46 | $2,290.87 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $398.11 Median $426.58 Typical High $446.68 | Professional | 52 · Reduced service | $398.11 | $426.58 | $446.68 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $162.18 Median $173.78 Typical High $181.97 | Professional | 53 · Discontinued | $162.18 | $173.78 | $181.97 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $645.65 Typical High $676.08 | Professional | 54 · Surgery only | $602.56 | $645.65 | $676.08 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $128.82 Typical High $134.90 | Professional | 55 · Aftercare only | $120.23 | $128.82 | $134.90 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $87.10 Typical High $91.20 | Professional | 56 · Pre-op care only | $81.28 | $87.10 | $91.20 |
Where Pennsylvania sits
The same service costs 7.4 times more in Oklahoma 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· 43rd of 51
$912
OK $3,890TX $525
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.