How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,089 · 10th to 90th $1,698 to $3,236
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 $1,905.46 Median $2,089.30 Typical High $2,089.30 | Professional | None | $1,905.46 | $2,089.30 | $2,089.30 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,318.26 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,318.26 | $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 $2,754.23 Median $2,754.23 Typical High $56,234.13 | Professional | None | $2,754.23 | $2,754.23 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,479.11 Median $2,290.87 Typical High $3,090.30 | Professional | 78 · Unplanned return to OR | $1,479.11 | $2,290.87 | $3,090.30 |
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 $1,698.24 Median $2,041.74 Typical High $3,548.13 | Professional | None | $1,698.24 | $2,041.74 | $3,548.13 |
Emblem Health Setting Professional Modifier None Typical Low $2,630.27 Median $2,630.27 Typical High $2,951.21 | Professional | None | $2,630.27 | $2,630.27 | $2,951.21 |
Geisinger Setting Professional Modifier None Typical Low $1,778.28 Median $2,398.83 Typical High $3,981.07 | Professional | None | $1,778.28 | $2,398.83 | $3,981.07 |
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 $1,905.46 Median $2,089.30 Typical High $2,089.30 | Professional | None | $1,905.46 | $2,089.30 | $2,089.30 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,318.26 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,318.26 | $1,479.11 | $1,479.11 |
Oscar Health Setting Professional Modifier None Typical Low $25.12 Median $2,511.89 Typical High $3,715.35 | Professional | None | $25.12 | $2,511.89 | $3,715.35 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,698.24 Median $3,090.30 Typical High $3,090.30 | Facility | None | $1,698.24 | $3,090.30 | $3,090.30 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,698.24 Median $1,819.70 Typical High $3,090.30 | Professional | None | $1,698.24 | $1,819.70 | $3,090.30 |
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 $2,187.76 Typical High $3,715.35 | Professional | None | $1,659.59 | $2,187.76 | $3,715.35 |
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 $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $954.99 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $380.19 Median $416.87 Typical High $426.58 | Professional | 53 · Discontinued | $380.19 | $416.87 | $426.58 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,412.54 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,412.54 | $1,584.89 | $1,584.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $281.84 Median $316.23 Typical High $316.23 | Professional | 55 · Aftercare only | $281.84 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $190.55 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $190.55 | $208.93 | $208.93 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $954.99 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $954.99 | $1,047.13 | $1,047.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $380.19 Median $416.87 Typical High $426.58 | Professional | 53 · Discontinued | $380.19 | $416.87 | $426.58 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,412.54 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,412.54 | $1,584.89 | $1,584.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $281.84 Median $316.23 Typical High $316.23 | Professional | 55 · Aftercare only | $281.84 | $316.23 | $316.23 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $190.55 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $190.55 | $208.93 | $208.93 |
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· 39th of 51
$1,995
AK $7,079TX $1,288
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.