How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $3,981 · 10th to 90th $3,236 to $6,457
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 $3,388.44 Median $3,981.07 Typical High $4,073.80 | Professional | None | $3,388.44 | $3,981.07 | $4,073.80 |
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 $3,311.31 Median $4,786.30 Typical High $6,760.83 | Professional | None | $3,311.31 | $4,786.30 | $6,760.83 |
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 $3,235.94 Median $3,890.45 Typical High $6,760.83 | Professional | None | $3,235.94 | $3,890.45 | $6,760.83 |
Emblem Health Setting Professional Modifier None Typical Low $5,011.87 Median $5,011.87 Typical High $5,623.41 | Professional | None | $5,011.87 | $5,011.87 | $5,623.41 |
Geisinger Setting Professional Modifier None Typical Low $3,467.37 Median $4,570.88 Typical High $6,918.31 | Professional | None | $3,467.37 | $4,570.88 | $6,918.31 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $4,073.80 Typical High $8,709.64 | Facility | None | $831.76 | $4,073.80 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $3,467.37 Median $3,981.07 Typical High $4,073.80 | Professional | None | $3,467.37 | $3,981.07 | $4,073.80 |
Oscar Health Setting Professional Modifier None Typical Low $25.12 Median $25.12 Typical High $25.12 | Professional | None | $25.12 | $25.12 | $25.12 |
UPMC Health Plan Setting Facility Modifier None Typical Low $3,311.31 Median $3,890.45 Typical High $3,890.45 | Facility | None | $3,311.31 | $3,890.45 | $3,890.45 |
UPMC Health Plan Setting Professional Modifier None Typical Low $3,311.31 Median $3,388.44 Typical High $3,890.45 | Professional | None | $3,311.31 | $3,388.44 | $3,890.45 |
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 $3,162.28 Median $4,466.84 Typical High $7,079.46 | Professional | None | $3,162.28 | $4,466.84 | $7,079.46 |
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 $1,819.70 Median $1,995.26 Typical High $1,995.26 | Professional | 52 · Reduced service | $1,819.70 | $1,995.26 | $1,995.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $724.44 Median $812.83 Typical High $812.83 | Professional | 53 · Discontinued | $724.44 | $812.83 | $812.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,691.53 Median $3,019.95 Typical High $3,019.95 | Professional | 54 · Surgery only | $2,691.53 | $3,019.95 | $3,019.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $549.54 Median $602.56 Typical High $602.56 | Professional | 55 · Aftercare only | $549.54 | $602.56 | $602.56 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $363.08 Median $398.11 Typical High $407.38 | Professional | 56 · Pre-op care only | $363.08 | $398.11 | $407.38 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,818.38 Median $3,981.07 Typical High $5,623.41 | Professional | 78 · Unplanned return to OR | $2,818.38 | $3,981.07 | $5,623.41 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,819.70 Median $1,995.26 Typical High $1,995.26 | Professional | 52 · Reduced service | $1,819.70 | $1,995.26 | $1,995.26 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $724.44 Median $812.83 Typical High $812.83 | Professional | 53 · Discontinued | $724.44 | $812.83 | $812.83 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,691.53 Median $3,019.95 Typical High $3,019.95 | Professional | 54 · Surgery only | $2,691.53 | $3,019.95 | $3,019.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $549.54 Median $602.56 Typical High $602.56 | Professional | 55 · Aftercare only | $549.54 | $602.56 | $602.56 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $363.08 Median $398.11 Typical High $407.38 | Professional | 56 · Pre-op care only | $363.08 | $398.11 | $407.38 |
Where Pennsylvania sits
The same service costs 7.4 times more in Alaska than in Arkansas. 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· 38th of 51
$3,715
AK $13,490AR $1,820
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.