How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,862 · 10th to 90th $1,514 to $3,020
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 $1,659.59 Median $1,862.09 Typical High $1,862.09 | Professional | None | $1,659.59 | $1,862.09 | $1,862.09 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $1,288.25 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,174.90 | $1,288.25 | $1,318.26 |
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 $2,454.71 Median $2,454.71 Typical High $56,234.13 | Professional | None | $2,454.71 | $2,454.71 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,318.26 Median $1,995.26 Typical High $2,570.40 | Professional | 78 · Unplanned return to OR | $1,318.26 | $1,995.26 | $2,570.40 |
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 $1,513.56 Median $1,737.80 Typical High $3,162.28 | Professional | None | $1,513.56 | $1,737.80 | $3,162.28 |
Emblem Health Setting Professional Modifier None Typical Low $2,344.23 Median $2,344.23 Typical High $2,630.27 | Professional | None | $2,344.23 | $2,344.23 | $2,630.27 |
Geisinger Setting Professional Modifier None Typical Low $1,584.89 Median $2,137.96 Typical High $3,548.13 | Professional | None | $1,584.89 | $2,137.96 | $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 $1,659.59 Median $1,862.09 Typical High $1,862.09 | Professional | None | $1,659.59 | $1,862.09 | $1,862.09 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $1,288.25 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,174.90 | $1,288.25 | $1,318.26 |
Oscar Health Setting Professional Modifier None Typical Low $19.95 Median $2,344.23 Typical High $3,311.31 | Professional | None | $19.95 | $2,344.23 | $3,311.31 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,513.56 Median $2,398.83 Typical High $2,398.83 | Facility | None | $1,513.56 | $2,398.83 | $2,398.83 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,513.56 Median $1,584.89 Typical High $2,398.83 | Professional | None | $1,513.56 | $1,584.89 | $2,398.83 |
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 $1,445.44 Median $1,995.26 Typical High $3,235.94 | Professional | None | $1,445.44 | $1,995.26 | $3,235.94 |
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 $831.76 Median $933.25 Typical High $933.25 | Professional | 52 · Reduced service | $831.76 | $933.25 | $933.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $331.13 Median $371.54 Typical High $371.54 | Professional | 53 · Discontinued | $331.13 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $1,380.38 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,258.93 | $1,380.38 | $1,412.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $281.84 Typical High $281.84 | Professional | 55 · Aftercare only | $251.19 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $165.96 Median $186.21 Typical High $186.21 | Professional | 56 · Pre-op care only | $165.96 | $186.21 | $186.21 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $831.76 Median $933.25 Typical High $933.25 | Professional | 52 · Reduced service | $831.76 | $933.25 | $933.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $331.13 Median $371.54 Typical High $371.54 | Professional | 53 · Discontinued | $331.13 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $1,380.38 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,258.93 | $1,380.38 | $1,412.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $281.84 Typical High $281.84 | Professional | 55 · Aftercare only | $251.19 | $281.84 | $281.84 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $165.96 Median $186.21 Typical High $186.21 | Professional | 56 · Pre-op care only | $165.96 | $186.21 | $186.21 |
Where Pennsylvania sits
The same service costs 5.5 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· 41st of 51
$1,738
AK $6,310TX $1,148
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.