How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,698 · 10th to 90th $1,380 to $2,754
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 $1,548.82 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,548.82 | $1,698.24 | $1,698.24 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,202.26 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,202.26 | $1,202.26 |
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 $1,412.54 Median $2,238.72 Typical High $2,818.38 | Professional | None | $1,412.54 | $2,238.72 | $2,818.38 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $1,819.70 Typical High $2,344.23 | Professional | 78 · Unplanned return to OR | $1,202.26 | $1,819.70 | $2,344.23 |
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 $1,380.38 Median $1,548.82 Typical High $2,884.03 | Professional | None | $1,380.38 | $1,548.82 | $2,884.03 |
Emblem Health Setting Professional Modifier None Typical Low $2,187.76 Median $2,187.76 Typical High $2,398.83 | Professional | None | $2,187.76 | $2,187.76 | $2,398.83 |
Geisinger Setting Professional Modifier None Typical Low $1,380.38 Median $1,949.84 Typical High $3,090.30 | Professional | None | $1,380.38 | $1,949.84 | $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 $1,548.82 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,548.82 | $1,698.24 | $1,698.24 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,202.26 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,202.26 | $1,202.26 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $1,584.89 Typical High $2,884.03 | Professional | None | $15.14 | $1,584.89 | $2,884.03 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,380.38 Median $1,621.81 Typical High $1,621.81 | Facility | None | $1,380.38 | $1,621.81 | $1,621.81 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,380.38 Median $1,445.44 Typical High $1,621.81 | Professional | None | $1,380.38 | $1,445.44 | $1,621.81 |
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 $1,348.96 Median $1,778.28 Typical High $2,951.21 | Professional | None | $1,348.96 | $1,778.28 | $2,951.21 |
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 $776.25 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $776.25 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $338.84 Typical High $346.74 | Professional | 53 · Discontinued | $309.03 | $338.84 | $346.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $1,288.25 Typical High $1,288.25 | Professional | 54 · Surgery only | $1,148.15 | $1,288.25 | $1,288.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $257.04 Typical High $257.04 | Professional | 55 · Aftercare only | $229.09 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $169.82 Typical High $169.82 | Professional | 56 · Pre-op care only | $154.88 | $169.82 | $169.82 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $2,137.96 Median $3,235.94 Typical High $4,168.69 | Professional | 50 · Both sides | $2,137.96 | $3,235.94 | $4,168.69 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $776.25 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $776.25 | $851.14 | $851.14 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $338.84 Typical High $346.74 | Professional | 53 · Discontinued | $309.03 | $338.84 | $346.74 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $1,288.25 Typical High $1,288.25 | Professional | 54 · Surgery only | $1,148.15 | $1,288.25 | $1,288.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $257.04 Typical High $257.04 | Professional | 55 · Aftercare only | $229.09 | $257.04 | $257.04 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $169.82 Typical High $169.82 | Professional | 56 · Pre-op care only | $154.88 | $169.82 | $169.82 |
Where Pennsylvania sits
The same service costs 5.6 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
$1,585
AK $5,754TX $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.