How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $3,802 · 10th to 90th $3,090 to $5,888
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 $3,388.44 Median $3,801.89 Typical High $3,801.89 | Professional | None | $3,388.44 | $3,801.89 | $3,801.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,398.83 Median $2,691.53 Typical High $2,691.53 | Professional | 78 · Unplanned return to OR | $2,398.83 | $2,691.53 | $2,691.53 |
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 $5,011.87 Median $5,011.87 Typical High $56,234.13 | Professional | None | $5,011.87 | $5,011.87 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,630.27 Median $4,570.88 Typical High $6,309.57 | Professional | 78 · Unplanned return to OR | $2,630.27 | $4,570.88 | $6,309.57 |
Cigna Setting Facility Modifier None Typical Low $380.19 Median $645.65 Typical High $2,290.87 | Facility | None | $380.19 | $645.65 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $3,090.30 Median $3,630.78 Typical High $6,456.54 | Professional | None | $3,090.30 | $3,630.78 | $6,456.54 |
Emblem Health Setting Professional Modifier None Typical Low $4,677.35 Median $4,677.35 Typical High $5,248.07 | Professional | None | $4,677.35 | $4,677.35 | $5,248.07 |
Geisinger Setting Professional Modifier None Typical Low $3,235.94 Median $4,365.16 Typical High $7,413.10 | Professional | None | $3,235.94 | $4,365.16 | $7,413.10 |
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 $3,388.44 Median $3,801.89 Typical High $3,801.89 | Professional | None | $3,388.44 | $3,801.89 | $3,801.89 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,398.83 Median $2,691.53 Typical High $2,691.53 | Professional | 78 · Unplanned return to OR | $2,398.83 | $2,691.53 | $2,691.53 |
Oscar Health Setting Professional Modifier None Typical Low $25.12 Median $25.12 Typical High $25.12 | Professional | None | $25.12 | $25.12 | $25.12 |
UPMC Health Plan Setting Facility Modifier None Typical Low $3,090.30 Median $3,388.44 Typical High $3,388.44 | Facility | None | $3,090.30 | $3,388.44 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $3,090.30 Median $3,235.94 Typical High $3,388.44 | Professional | None | $3,090.30 | $3,235.94 | $3,388.44 |
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 $3,019.95 Median $4,168.69 Typical High $6,606.93 | Professional | None | $3,019.95 | $4,168.69 | $6,606.93 |
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 $1,698.24 Median $1,905.46 Typical High $1,905.46 | Professional | 52 · Reduced service | $1,698.24 | $1,905.46 | $1,905.46 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $691.83 Median $758.58 Typical High $758.58 | Professional | 53 · Discontinued | $691.83 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,570.40 Median $2,884.03 Typical High $2,884.03 | Professional | 54 · Surgery only | $2,570.40 | $2,884.03 | $2,884.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $512.86 Median $575.44 Typical High $575.44 | Professional | 55 · Aftercare only | $512.86 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $338.84 Median $380.19 Typical High $380.19 | Professional | 56 · Pre-op care only | $338.84 | $380.19 | $380.19 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,698.24 Median $1,905.46 Typical High $1,905.46 | Professional | 52 · Reduced service | $1,698.24 | $1,905.46 | $1,905.46 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $691.83 Median $758.58 Typical High $758.58 | Professional | 53 · Discontinued | $691.83 | $758.58 | $758.58 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,570.40 Median $2,884.03 Typical High $2,884.03 | Professional | 54 · Surgery only | $2,570.40 | $2,884.03 | $2,884.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $512.86 Median $575.44 Typical High $575.44 | Professional | 55 · Aftercare only | $512.86 | $575.44 | $575.44 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $338.84 Median $380.19 Typical High $380.19 | Professional | 56 · Pre-op care only | $338.84 | $380.19 | $380.19 |
Where Pennsylvania sits
The same service costs 7.1 times more in Alaska than in Arkansas. 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
$3,467
AK $12,882AR $1,820
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.