How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,660 · 10th to 90th $1,318 to $2,630
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 $1,479.11 Median $1,659.59 Typical High $1,659.59 | Professional | None | $1,479.11 | $1,659.59 | $1,659.59 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $1,148.15 Typical High $1,148.15 | Professional | 78 · Unplanned return to OR | $1,023.29 | $1,148.15 | $1,148.15 |
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 $2,754.23 | Professional | None | $2,754.23 | $2,754.23 | $2,754.23 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,148.15 Median $1,778.28 Typical High $2,290.87 | Professional | 78 · Unplanned return to OR | $1,148.15 | $1,778.28 | $2,290.87 |
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 $1,318.26 Median $1,548.82 Typical High $2,818.38 | Professional | None | $1,318.26 | $1,548.82 | $2,818.38 |
Emblem Health Setting Professional Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,344.23 | Professional | None | $2,089.30 | $2,089.30 | $2,344.23 |
Geisinger Setting Professional Modifier None Typical Low $1,380.38 Median $1,862.09 Typical High $3,090.30 | Professional | None | $1,380.38 | $1,862.09 | $3,090.30 |
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 $1,479.11 Median $1,659.59 Typical High $1,659.59 | Professional | None | $1,479.11 | $1,659.59 | $1,659.59 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $1,148.15 Typical High $1,148.15 | Professional | 78 · Unplanned return to OR | $1,023.29 | $1,148.15 | $1,148.15 |
Oscar Health Setting Professional Modifier None Typical Low $25.12 Median $2,041.74 Typical High $2,884.03 | Professional | None | $25.12 | $2,041.74 | $2,884.03 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,348.96 Median $2,187.76 Typical High $2,187.76 | Facility | None | $1,348.96 | $2,187.76 | $2,187.76 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,348.96 Median $1,412.54 Typical High $2,187.76 | Professional | None | $1,348.96 | $1,412.54 | $2,187.76 |
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 $1,288.25 Median $1,737.80 Typical High $2,884.03 | Professional | None | $1,288.25 | $1,737.80 | $2,884.03 |
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 $741.31 Median $812.83 Typical High $831.76 | Professional | 52 · Reduced service | $741.31 | $812.83 | $831.76 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $331.13 Typical High $331.13 | Professional | 53 · Discontinued | $295.12 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,230.27 Typical High $1,230.27 | Professional | 54 · Surgery only | $1,096.48 | $1,230.27 | $1,230.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $245.47 Typical High $245.47 | Professional | 55 · Aftercare only | $223.87 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $165.96 Typical High $165.96 | Professional | 56 · Pre-op care only | $147.91 | $165.96 | $165.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $741.31 Median $812.83 Typical High $831.76 | Professional | 52 · Reduced service | $741.31 | $812.83 | $831.76 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $331.13 Typical High $331.13 | Professional | 53 · Discontinued | $295.12 | $331.13 | $331.13 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,230.27 Typical High $1,230.27 | Professional | 54 · Surgery only | $1,096.48 | $1,230.27 | $1,230.27 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $245.47 Typical High $245.47 | Professional | 55 · Aftercare only | $223.87 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $165.96 Typical High $165.96 | Professional | 56 · Pre-op care only | $147.91 | $165.96 | $165.96 |
Where Pennsylvania sits
The same service costs 5.4 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· 40th of 51
$1,549
AK $5,495TX $1,023
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.