How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,455 · 10th to 90th $1,995 to $3,981
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 $2,290.87 Median $2,570.40 Typical High $2,570.40 | Professional | None | $2,290.87 | $2,570.40 | $2,570.40 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,621.81 Median $1,819.70 Typical High $1,819.70 | Professional | 78 · Unplanned return to OR | $1,621.81 | $1,819.70 | $1,819.70 |
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 $3,388.44 Median $3,388.44 Typical High $56,234.13 | Professional | None | $3,388.44 | $3,388.44 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,819.70 Median $2,754.23 Typical High $3,630.78 | Professional | 78 · Unplanned return to OR | $1,819.70 | $2,754.23 | $3,630.78 |
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 $1,905.46 Median $2,398.83 Typical High $4,365.16 | Professional | None | $1,905.46 | $2,398.83 | $4,365.16 |
Emblem Health Setting Professional Modifier None Typical Low $3,235.94 Median $3,235.94 Typical High $3,630.78 | Professional | None | $3,235.94 | $3,235.94 | $3,630.78 |
Geisinger Setting Professional Modifier None Typical Low $1,479.11 Median $2,951.21 Typical High $4,570.88 | Professional | None | $1,479.11 | $2,951.21 | $4,570.88 |
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 $2,290.87 Median $2,570.40 Typical High $2,570.40 | Professional | None | $2,290.87 | $2,570.40 | $2,570.40 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,621.81 Median $1,819.70 Typical High $1,819.70 | Professional | 78 · Unplanned return to OR | $1,621.81 | $1,819.70 | $1,819.70 |
Oscar Health Setting Professional Modifier None Typical Low $19.95 Median $1,995.26 Typical High $4,168.69 | Professional | None | $19.95 | $1,995.26 | $4,168.69 |
UPMC Health Plan Setting Facility Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Facility | None | $2,089.30 | $2,089.30 | $2,089.30 |
UPMC Health Plan Setting Professional Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Professional | None | $2,089.30 | $2,089.30 | $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 $1,995.26 Median $2,511.89 Typical High $4,466.84 | Professional | None | $1,995.26 | $2,511.89 | $4,466.84 |
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 $1,148.15 Median $1,288.25 Typical High $1,288.25 | Professional | 52 · Reduced service | $1,148.15 | $1,288.25 | $1,288.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $467.74 Median $512.86 Typical High $512.86 | Professional | 53 · Discontinued | $467.74 | $512.86 | $512.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,737.80 Median $1,949.84 Typical High $1,949.84 | Professional | 54 · Surgery only | $1,737.80 | $1,949.84 | $1,949.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $346.74 Median $389.05 Typical High $389.05 | Professional | 55 · Aftercare only | $346.74 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $229.09 Median $257.04 Typical High $257.04 | Professional | 56 · Pre-op care only | $229.09 | $257.04 | $257.04 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,148.15 Median $1,288.25 Typical High $1,288.25 | Professional | 52 · Reduced service | $1,148.15 | $1,288.25 | $1,288.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $467.74 Median $512.86 Typical High $512.86 | Professional | 53 · Discontinued | $467.74 | $512.86 | $512.86 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,737.80 Median $1,949.84 Typical High $1,949.84 | Professional | 54 · Surgery only | $1,737.80 | $1,949.84 | $1,949.84 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $346.74 Median $389.05 Typical High $389.05 | Professional | 55 · Aftercare only | $346.74 | $389.05 | $389.05 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $229.09 Median $257.04 Typical High $257.04 | Professional | 56 · Pre-op care only | $229.09 | $257.04 | $257.04 |
Where Pennsylvania sits
The same service costs 5.2 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· 43rd of 51
$2,291
AK $8,710TX $1,660
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.