How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,585 · 10th to 90th $1,259 to $2,692
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 $1,412.54 Median $1,584.89 Typical High $1,584.89 | Professional | None | $1,412.54 | $1,584.89 | $1,584.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,096.48 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,096.48 | $1,096.48 |
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 $2,137.96 Median $2,570.40 Typical High $3,311.31 | Professional | None | $2,137.96 | $2,570.40 | $3,311.31 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,778.28 Typical High $2,511.89 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,778.28 | $2,511.89 |
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 $1,258.93 Median $1,621.81 Typical High $2,691.53 | Professional | None | $1,258.93 | $1,621.81 | $2,691.53 |
Emblem Health Setting Professional Modifier None Typical Low $1,862.09 Median $1,862.09 Typical High $2,137.96 | Professional | None | $1,862.09 | $1,862.09 | $2,137.96 |
Geisinger Setting Professional Modifier None Typical Low $1,412.54 Median $1,778.28 Typical High $3,019.95 | Professional | None | $1,412.54 | $1,778.28 | $3,019.95 |
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 $1,412.54 Median $1,584.89 Typical High $1,584.89 | Professional | None | $1,412.54 | $1,584.89 | $1,584.89 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,096.48 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,096.48 | $1,096.48 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $1,258.93 Typical High $2,951.21 | Professional | None | $15.14 | $1,258.93 | $2,951.21 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,288.25 Median $1,548.82 Typical High $1,548.82 | Facility | None | $1,288.25 | $1,548.82 | $1,548.82 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,288.25 Median $1,348.96 Typical High $1,548.82 | Professional | None | $1,288.25 | $1,348.96 | $1,548.82 |
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 $1,230.27 Median $1,737.80 Typical High $2,754.23 | Professional | None | $1,230.27 | $1,737.80 | $2,754.23 |
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 $707.95 Median $794.33 Typical High $794.33 | Professional | 52 · Reduced service | $707.95 | $794.33 | $794.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $281.84 Median $316.23 Typical High $316.23 | Professional | 53 · Discontinued | $281.84 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,174.90 Typical High $1,174.90 | Professional | 54 · Surgery only | $1,071.52 | $1,174.90 | $1,174.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $234.42 Typical High $234.42 | Professional | 55 · Aftercare only | $213.80 | $234.42 | $234.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $158.49 Typical High $158.49 | Professional | 56 · Pre-op care only | $141.25 | $158.49 | $158.49 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $707.95 Median $794.33 Typical High $794.33 | Professional | 52 · Reduced service | $707.95 | $794.33 | $794.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $281.84 Median $316.23 Typical High $316.23 | Professional | 53 · Discontinued | $281.84 | $316.23 | $316.23 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,174.90 Typical High $1,174.90 | Professional | 54 · Surgery only | $1,071.52 | $1,174.90 | $1,174.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $234.42 Typical High $234.42 | Professional | 55 · Aftercare only | $213.80 | $234.42 | $234.42 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $158.49 Typical High $158.49 | Professional | 56 · Pre-op care only | $141.25 | $158.49 | $158.49 |
Where Pennsylvania sits
The same service costs 4.9 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· 36th of 51
$1,585
AK $5,248TX $1,072
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.