How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,399 · 10th to 90th $1,950 to $3,715
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 $2,089.30 Median $2,398.83 Typical High $2,454.71 | Professional | None | $2,089.30 | $2,398.83 | $2,454.71 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,513.56 Median $1,698.24 Typical High $1,698.24 | Professional | 78 · Unplanned return to OR | $1,513.56 | $1,698.24 | $1,698.24 |
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 $3,235.94 Median $3,235.94 Typical High $56,234.13 | Professional | None | $3,235.94 | $3,235.94 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,698.24 Median $2,884.03 Typical High $4,073.80 | Professional | 78 · Unplanned return to OR | $1,698.24 | $2,884.03 | $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 $1,949.84 Median $2,290.87 Typical High $4,168.69 | Professional | None | $1,949.84 | $2,290.87 | $4,168.69 |
Emblem Health Setting Professional Modifier None Typical Low $3,019.95 Median $3,019.95 Typical High $3,388.44 | Professional | None | $3,019.95 | $3,019.95 | $3,388.44 |
Geisinger Setting Professional Modifier None Typical Low $2,089.30 Median $2,754.23 Typical High $4,677.35 | Professional | None | $2,089.30 | $2,754.23 | $4,677.35 |
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 $2,137.96 Median $2,398.83 Typical High $2,454.71 | Professional | None | $2,137.96 | $2,398.83 | $2,454.71 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,513.56 Median $1,698.24 Typical High $1,698.24 | Professional | 78 · Unplanned return to OR | $1,513.56 | $1,698.24 | $1,698.24 |
Oscar Health Setting Professional Modifier None Typical Low $25.12 Median $2,951.21 Typical High $4,466.84 | Professional | None | $25.12 | $2,951.21 | $4,466.84 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,995.26 Median $3,162.28 Typical High $3,162.28 | Facility | None | $1,995.26 | $3,162.28 | $3,162.28 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,995.26 Median $2,089.30 Typical High $3,162.28 | Professional | None | $1,995.26 | $2,089.30 | $3,162.28 |
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 $1,905.46 Median $2,630.27 Typical High $4,265.80 | Professional | None | $1,905.46 | $2,630.27 | $4,265.80 |
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 $1,096.48 Median $1,202.26 Typical High $1,230.27 | Professional | 52 · Reduced service | $1,096.48 | $1,202.26 | $1,230.27 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $436.52 Median $489.78 Typical High $489.78 | Professional | 53 · Discontinued | $436.52 | $489.78 | $489.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,621.81 Median $1,819.70 Typical High $1,819.70 | Professional | 54 · Surgery only | $1,621.81 | $1,819.70 | $1,819.70 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $323.59 Median $363.08 Typical High $363.08 | Professional | 55 · Aftercare only | $323.59 | $363.08 | $363.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $218.78 Median $239.88 Typical High $245.47 | Professional | 56 · Pre-op care only | $218.78 | $239.88 | $245.47 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,096.48 Median $1,202.26 Typical High $1,230.27 | Professional | 52 · Reduced service | $1,096.48 | $1,202.26 | $1,230.27 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $436.52 Median $489.78 Typical High $489.78 | Professional | 53 · Discontinued | $436.52 | $489.78 | $489.78 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,621.81 Median $1,819.70 Typical High $1,819.70 | Professional | 54 · Surgery only | $1,621.81 | $1,819.70 | $1,819.70 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $323.59 Median $363.08 Typical High $363.08 | Professional | 55 · Aftercare only | $323.59 | $363.08 | $363.08 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $218.78 Median $239.88 Typical High $245.47 | Professional | 56 · Pre-op care only | $218.78 | $239.88 | $245.47 |
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· 42nd of 51
$2,239
AK $8,128TX $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.