How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $3,162 · 10th to 90th $2,455 to $5,129
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 $2,884.03 Median $3,162.28 Typical High $3,235.94 | Professional | None | $2,884.03 | $3,162.28 | $3,235.94 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,041.74 Median $2,187.76 Typical High $2,238.72 | Professional | 78 · Unplanned return to OR | $2,041.74 | $2,187.76 | $2,238.72 |
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 $4,786.30 Median $4,786.30 Typical High $56,234.13 | Professional | None | $4,786.30 | $4,786.30 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,290.87 Median $3,630.78 Typical High $4,897.79 | Professional | 78 · Unplanned return to OR | $2,290.87 | $3,630.78 | $4,897.79 |
Cigna Setting Facility Modifier None Typical Low $120.23 Median $676.08 Typical High $2,290.87 | Facility | None | $120.23 | $676.08 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $2,691.53 Median $3,388.44 Typical High $6,025.60 | Professional | None | $2,691.53 | $3,388.44 | $6,025.60 |
Emblem Health Setting Professional Modifier None Typical Low $4,466.84 Median $4,466.84 Typical High $5,011.87 | Professional | None | $4,466.84 | $4,466.84 | $5,011.87 |
Geisinger Setting Professional Modifier None Typical Low $1,778.28 Median $3,630.78 Typical High $6,165.95 | Professional | None | $1,778.28 | $3,630.78 | $6,165.95 |
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 $2,884.03 Median $3,162.28 Typical High $3,235.94 | Professional | None | $2,884.03 | $3,162.28 | $3,235.94 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,041.74 Median $2,187.76 Typical High $2,238.72 | Professional | 78 · Unplanned return to OR | $2,041.74 | $2,187.76 | $2,238.72 |
Oscar Health Setting Professional Modifier None Typical Low $18.20 Median $2,238.72 Typical High $5,888.44 | Professional | None | $18.20 | $2,238.72 | $5,888.44 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $2,951.21 | Facility | None | $1,949.84 | $1,949.84 | $2,951.21 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $2,951.21 | Professional | None | $1,949.84 | $1,949.84 | $2,951.21 |
United Setting Facility Modifier None Typical Low $199.53 Median $562.34 Typical High $4,265.80 | Facility | None | $199.53 | $562.34 | $4,265.80 |
United Setting Professional Modifier None Typical Low $2,570.40 Median $3,162.28 Typical High $6,309.57 | Professional | None | $2,570.40 | $3,162.28 | $6,309.57 |
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 $1,445.44 Median $1,584.89 Typical High $1,621.81 | Professional | 52 · Reduced service | $1,445.44 | $1,584.89 | $1,621.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $588.84 Median $630.96 Typical High $645.65 | Professional | 53 · Discontinued | $588.84 | $630.96 | $645.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,187.76 Median $2,344.23 Typical High $2,398.83 | Professional | 54 · Surgery only | $2,187.76 | $2,344.23 | $2,398.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $436.52 Median $467.74 Typical High $478.63 | Professional | 55 · Aftercare only | $436.52 | $467.74 | $478.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $288.40 Median $316.23 Typical High $323.59 | Professional | 56 · Pre-op care only | $288.40 | $316.23 | $323.59 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,445.44 Median $1,584.89 Typical High $1,621.81 | Professional | 52 · Reduced service | $1,445.44 | $1,584.89 | $1,621.81 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $588.84 Median $630.96 Typical High $645.65 | Professional | 53 · Discontinued | $588.84 | $630.96 | $645.65 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,187.76 Median $2,344.23 Typical High $2,398.83 | Professional | 54 · Surgery only | $2,187.76 | $2,344.23 | $2,398.83 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $436.52 Median $467.74 Typical High $478.63 | Professional | 55 · Aftercare only | $436.52 | $467.74 | $478.63 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $288.40 Median $316.23 Typical High $323.59 | Professional | 56 · Pre-op care only | $288.40 | $316.23 | $323.59 |
Where Pennsylvania sits
The same service costs 12.6 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· 40th of 51
$3,020
AK $12,023TX $955
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.