How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,291 · 10th to 90th $1,820 to $3,802
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 $1,905.46 Median $2,290.87 Typical High $2,290.87 | Professional | None | $1,905.46 | $2,290.87 | $2,290.87 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $1,584.89 Typical High $1,584.89 | Professional | 78 · Unplanned return to OR | $1,445.44 | $1,584.89 | $1,584.89 |
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 $1,905.46 Median $3,235.94 Typical High $3,890.45 | Professional | None | $1,905.46 | $3,235.94 | $3,890.45 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,584.89 Median $2,691.53 Typical High $3,311.31 | Professional | 78 · Unplanned return to OR | $1,584.89 | $2,691.53 | $3,311.31 |
Cigna Setting Facility Modifier None Typical Low $380.19 Median $645.65 Typical High $2,290.87 | Facility | None | $380.19 | $645.65 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,819.70 Median $2,187.76 Typical High $3,890.45 | Professional | None | $1,819.70 | $2,187.76 | $3,890.45 |
Emblem Health Setting Professional Modifier None Typical Low $2,754.23 Median $2,754.23 Typical High $3,090.30 | Professional | None | $2,754.23 | $2,754.23 | $3,090.30 |
Geisinger Setting Professional Modifier None Typical Low $1,949.84 Median $2,570.40 Typical High $3,801.89 | Professional | None | $1,949.84 | $2,570.40 | $3,801.89 |
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 $1,905.46 Median $2,290.87 Typical High $2,290.87 | Professional | None | $1,905.46 | $2,290.87 | $2,290.87 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $1,584.89 Typical High $1,584.89 | Professional | 78 · Unplanned return to OR | $1,445.44 | $1,584.89 | $1,584.89 |
Oscar Health Setting Professional Modifier None Typical Low $19.95 Median $19.95 Typical High $19.95 | Professional | None | $19.95 | $19.95 | $19.95 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,862.09 Median $2,137.96 Typical High $2,137.96 | Facility | None | $1,862.09 | $2,137.96 | $2,137.96 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,862.09 Median $1,949.84 Typical High $2,137.96 | Professional | None | $1,862.09 | $1,949.84 | $2,137.96 |
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 $1,778.28 Median $2,511.89 Typical High $3,981.07 | Professional | None | $1,778.28 | $2,511.89 | $3,981.07 |
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 $1,023.29 Median $1,148.15 Typical High $1,148.15 | Professional | 52 · Reduced service | $1,023.29 | $1,148.15 | $1,148.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $407.38 Median $457.09 Typical High $457.09 | Professional | 53 · Discontinued | $407.38 | $457.09 | $457.09 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,548.82 Median $1,698.24 Typical High $1,698.24 | Professional | 54 · Surgery only | $1,548.82 | $1,698.24 | $1,698.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $309.03 Median $338.84 Typical High $346.74 | Professional | 55 · Aftercare only | $309.03 | $338.84 | $346.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $204.17 Median $229.09 Typical High $229.09 | Professional | 56 · Pre-op care only | $204.17 | $229.09 | $229.09 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,023.29 Median $1,148.15 Typical High $1,148.15 | Professional | 52 · Reduced service | $1,023.29 | $1,148.15 | $1,148.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $407.38 Median $457.09 Typical High $457.09 | Professional | 53 · Discontinued | $407.38 | $457.09 | $457.09 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,548.82 Median $1,698.24 Typical High $1,698.24 | Professional | 54 · Surgery only | $1,548.82 | $1,698.24 | $1,698.24 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $309.03 Median $338.84 Typical High $346.74 | Professional | 55 · Aftercare only | $309.03 | $338.84 | $346.74 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $204.17 Median $229.09 Typical High $229.09 | Professional | 56 · Pre-op care only | $204.17 | $229.09 | $229.09 |
Where Pennsylvania sits
The same service costs 8.0 times more in Alabama than in Washington. 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 $20,353WA $2,540
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.