How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,138 · 10th to 90th $1,698 to $3,467
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 $1,819.70 Median $2,137.96 Typical High $2,290.87 | Professional | None | $1,819.70 | $2,137.96 | $2,290.87 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,479.11 | $1,479.11 |
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 $1,778.28 Median $3,019.95 Typical High $3,715.35 | Professional | None | $1,778.28 | $3,019.95 | $3,715.35 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,479.11 Median $2,511.89 Typical High $3,162.28 | Professional | 78 · Unplanned return to OR | $1,479.11 | $2,511.89 | $3,162.28 |
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 $1,698.24 Median $2,137.96 Typical High $3,630.78 | Professional | None | $1,698.24 | $2,137.96 | $3,630.78 |
Emblem Health Setting Professional Modifier None Typical Low $2,454.71 Median $2,454.71 Typical High $2,754.23 | Professional | None | $2,454.71 | $2,454.71 | $2,754.23 |
Geisinger Setting Professional Modifier None Typical Low $1,819.70 Median $2,344.23 Typical High $3,548.13 | Professional | None | $1,819.70 | $2,344.23 | $3,548.13 |
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 $1,819.70 Median $2,137.96 Typical High $2,398.83 | Professional | None | $1,819.70 | $2,137.96 | $2,398.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,479.11 | $1,479.11 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $1,949.84 Typical High $1,995.26 | Professional | None | $15.14 | $1,949.84 | $1,995.26 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,737.80 Median $2,089.30 Typical High $2,089.30 | Facility | None | $1,737.80 | $2,089.30 | $2,089.30 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,737.80 Median $1,819.70 Typical High $2,089.30 | Professional | None | $1,737.80 | $1,819.70 | $2,089.30 |
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 $1,659.59 Median $2,344.23 Typical High $3,801.89 | Professional | None | $1,659.59 | $2,344.23 | $3,801.89 |
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 $954.99 Median $1,071.52 Typical High $1,071.52 | Professional | 52 · Reduced service | $954.99 | $1,071.52 | $1,071.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $380.19 Median $426.58 Typical High $426.58 | Professional | 53 · Discontinued | $380.19 | $426.58 | $426.58 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,445.44 | $1,584.89 | $1,584.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $316.23 Typical High $323.59 | Professional | 55 · Aftercare only | $288.40 | $316.23 | $323.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $190.55 Median $213.80 Typical High $213.80 | Professional | 56 · Pre-op care only | $190.55 | $213.80 | $213.80 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $954.99 Median $1,071.52 Typical High $1,071.52 | Professional | 52 · Reduced service | $954.99 | $1,071.52 | $1,071.52 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $380.19 Median $426.58 Typical High $426.58 | Professional | 53 · Discontinued | $380.19 | $426.58 | $426.58 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,445.44 | $1,584.89 | $1,584.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $316.23 Typical High $323.59 | Professional | 55 · Aftercare only | $288.40 | $316.23 | $323.59 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $190.55 Median $213.80 Typical High $213.80 | Professional | 56 · Pre-op care only | $190.55 | $213.80 | $213.80 |
Where Pennsylvania sits
The same service costs 7.3 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 $17,246WA $2,358
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.