How much rates vary
Facilitymedian $3,162 · 10th to 90th $631 to $8,511Professionalmedian $1,175 · 10th to 90th $933 to $1,905
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 $1,047.13 Median $1,174.90 Typical High $1,174.90 | Professional | None | $1,047.13 | $1,174.90 | $1,174.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $812.83 Typical High $812.83 | Professional | 78 · Unplanned return to OR | $741.31 | $812.83 | $812.83 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $12,022.64 Typical High $56,234.13 | Facility | None | $3,981.07 | $12,022.64 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $977.24 Median $1,548.82 Typical High $2,041.74 | Professional | None | $977.24 | $1,548.82 | $2,041.74 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $812.83 Median $1,258.93 Typical High $1,659.59 | Professional | 78 · Unplanned return to OR | $812.83 | $1,258.93 | $1,659.59 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $2,691.53 Typical High $5,128.61 | Facility | None | $501.19 | $2,691.53 | $5,128.61 |
Cigna Setting Professional Modifier None Typical Low $933.25 Median $1,122.02 Typical High $1,995.26 | Professional | None | $933.25 | $1,122.02 | $1,995.26 |
Emblem Health Setting Professional Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $1,584.89 | Professional | None | $1,412.54 | $1,412.54 | $1,584.89 |
Geisinger Setting Professional Modifier None Typical Low $1,047.13 Median $1,348.96 Typical High $2,238.72 | Professional | None | $1,047.13 | $1,348.96 | $2,238.72 |
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 $1,047.13 Median $1,174.90 Typical High $1,174.90 | Professional | None | $1,047.13 | $1,174.90 | $1,174.90 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $812.83 Typical High $812.83 | Professional | 78 · Unplanned return to OR | $741.31 | $812.83 | $812.83 |
Oscar Health Setting Professional Modifier None Typical Low $1,047.13 Median $1,047.13 Typical High $2,187.76 | Professional | None | $1,047.13 | $1,047.13 | $2,187.76 |
UPMC Health Plan Setting Facility Modifier None Typical Low $954.99 Median $1,023.29 Typical High $1,023.29 | Facility | None | $954.99 | $1,023.29 | $1,023.29 |
UPMC Health Plan Setting Professional Modifier None Typical Low $954.99 Median $1,000.00 Typical High $1,023.29 | Professional | None | $954.99 | $1,000.00 | $1,023.29 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,235.94 Typical High $8,511.38 | Facility | None | $1,698.24 | $3,235.94 | $8,511.38 |
United Setting Professional Modifier None Typical Low $912.01 Median $1,288.25 Typical High $2,041.74 | Professional | None | $912.01 | $1,288.25 | $2,041.74 |
11 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 $524.81 Median $588.84 Typical High $588.84 | Professional | 52 · Reduced service | $524.81 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $208.93 Median $234.42 Typical High $234.42 | Professional | 53 · Discontinued | $208.93 | $234.42 | $234.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $870.96 Typical High $870.96 | Professional | 54 · Surgery only | $794.33 | $870.96 | $870.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $173.78 Typical High $177.83 | Professional | 55 · Aftercare only | $158.49 | $173.78 | $177.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $104.71 Median $117.49 Typical High $117.49 | Professional | 56 · Pre-op care only | $104.71 | $117.49 | $117.49 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,445.44 Median $2,238.72 Typical High $3,019.95 | Professional | 50 · Both sides | $1,445.44 | $2,238.72 | $3,019.95 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $524.81 Median $588.84 Typical High $588.84 | Professional | 52 · Reduced service | $524.81 | $588.84 | $588.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $208.93 Median $234.42 Typical High $234.42 | Professional | 53 · Discontinued | $208.93 | $234.42 | $234.42 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $870.96 Typical High $870.96 | Professional | 54 · Surgery only | $794.33 | $870.96 | $870.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $173.78 Typical High $177.83 | Professional | 55 · Aftercare only | $158.49 | $173.78 | $177.83 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $104.71 Median $117.49 Typical High $117.49 | Professional | 56 · Pre-op care only | $104.71 | $117.49 | $117.49 |
Where Pennsylvania sits
The same service costs 5.0 times more in Wisconsin 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· 46th of 51
$1,175
WI $4,365TX $871
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.