How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,754 · 10th to 90th $2,042 to $4,266
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 $2,630.27 Median $2,884.03 Typical High $2,884.03 | Professional | None | $2,630.27 | $2,884.03 | $2,884.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,819.70 Median $2,041.74 Typical High $2,041.74 | Professional | 78 · Unplanned return to OR | $1,819.70 | $2,041.74 | $2,041.74 |
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 $3,801.89 Median $3,801.89 Typical High $56,234.13 | Professional | None | $3,801.89 | $3,801.89 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,041.74 Median $3,090.30 Typical High $4,073.80 | Professional | 78 · Unplanned return to OR | $2,041.74 | $3,090.30 | $4,073.80 |
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 $1,819.70 Median $2,754.23 Typical High $4,897.79 | Professional | None | $1,819.70 | $2,754.23 | $4,897.79 |
Emblem Health Setting Professional Modifier None Typical Low $3,548.13 Median $3,548.13 Typical High $3,981.07 | Professional | None | $3,548.13 | $3,548.13 | $3,981.07 |
Geisinger Setting Professional Modifier None Typical Low $1,905.46 Median $3,235.94 Typical High $4,897.79 | Professional | None | $1,905.46 | $3,235.94 | $4,897.79 |
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 $2,630.27 Median $2,884.03 Typical High $2,884.03 | Professional | None | $2,630.27 | $2,884.03 | $2,884.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,819.70 Median $2,041.74 Typical High $2,041.74 | Professional | 78 · Unplanned return to OR | $1,819.70 | $2,041.74 | $2,041.74 |
Oscar Health Setting Professional Modifier None Typical Low $19.95 Median $2,884.03 Typical High $3,890.45 | Professional | None | $19.95 | $2,884.03 | $3,890.45 |
UPMC Health Plan Setting Facility Modifier None Typical Low $2,041.74 Median $2,041.74 Typical High $2,344.23 | Facility | None | $2,041.74 | $2,041.74 | $2,344.23 |
UPMC Health Plan Setting Professional Modifier None Typical Low $2,041.74 Median $2,238.72 Typical High $2,344.23 | Professional | None | $2,041.74 | $2,238.72 | $2,344.23 |
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 $2,187.76 Median $2,691.53 Typical High $5,011.87 | Professional | None | $2,187.76 | $2,691.53 | $5,011.87 |
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 $1,288.25 Median $1,445.44 Typical High $1,445.44 | Professional | 52 · Reduced service | $1,288.25 | $1,445.44 | $1,445.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $524.81 Median $575.44 Typical High $575.44 | Professional | 53 · Discontinued | $524.81 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,949.84 Median $2,187.76 Typical High $2,187.76 | Professional | 54 · Surgery only | $1,949.84 | $2,187.76 | $2,187.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $389.05 Median $436.52 Typical High $436.52 | Professional | 55 · Aftercare only | $389.05 | $436.52 | $436.52 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $263.03 Median $288.40 Typical High $288.40 | Professional | 56 · Pre-op care only | $263.03 | $288.40 | $288.40 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,288.25 Median $1,445.44 Typical High $1,445.44 | Professional | 52 · Reduced service | $1,288.25 | $1,445.44 | $1,445.44 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $524.81 Median $575.44 Typical High $575.44 | Professional | 53 · Discontinued | $524.81 | $575.44 | $575.44 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,949.84 Median $2,187.76 Typical High $2,187.76 | Professional | 54 · Surgery only | $1,949.84 | $2,187.76 | $2,187.76 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $389.05 Median $436.52 Typical High $436.52 | Professional | 55 · Aftercare only | $389.05 | $436.52 | $436.52 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $263.03 Median $288.40 Typical High $288.40 | Professional | 56 · Pre-op care only | $263.03 | $288.40 | $288.40 |
Where Pennsylvania sits
The same service costs 6.3 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· 37th of 51
$2,630
AK $9,772TX $1,549
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.