How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,344 · 10th to 90th $1,738 to $3,981
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 $2,137.96 Median $2,454.71 Typical High $2,511.89 | Professional | None | $2,137.96 | $2,454.71 | $2,511.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,548.82 Median $1,737.80 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $1,548.82 | $1,737.80 | $1,737.80 |
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 $2,041.74 Median $3,311.31 Typical High $4,168.69 | Professional | None | $2,041.74 | $3,311.31 | $4,168.69 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,737.80 Median $2,691.53 Typical High $3,388.44 | Professional | 78 · Unplanned return to OR | $1,737.80 | $2,691.53 | $3,388.44 |
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 $1,737.80 Median $2,290.87 Typical High $4,265.80 | Professional | None | $1,737.80 | $2,290.87 | $4,265.80 |
Emblem Health Setting Professional Modifier None Typical Low $3,019.95 Median $3,019.95 Typical High $3,311.31 | Professional | None | $3,019.95 | $3,019.95 | $3,311.31 |
Geisinger Setting Professional Modifier None Typical Low $1,230.27 Median $2,754.23 Typical High $4,365.16 | Professional | None | $1,230.27 | $2,754.23 | $4,365.16 |
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 $2,137.96 Median $2,454.71 Typical High $2,511.89 | Professional | None | $2,137.96 | $2,454.71 | $2,511.89 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,548.82 Median $1,737.80 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $1,548.82 | $1,737.80 | $1,737.80 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $1,513.56 Typical High $3,981.07 | Professional | None | $15.14 | $1,513.56 | $3,981.07 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,202.26 Median $1,202.26 Typical High $2,041.74 | Facility | None | $1,202.26 | $1,202.26 | $2,041.74 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,202.26 Median $1,949.84 Typical High $2,041.74 | Professional | None | $1,202.26 | $1,949.84 | $2,041.74 |
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 $1,905.46 Median $2,398.83 Typical High $4,265.80 | Professional | None | $1,905.46 | $2,398.83 | $4,265.80 |
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 $1,122.02 Median $1,230.27 Typical High $1,230.27 | Professional | 52 · Reduced service | $1,122.02 | $1,230.27 | $1,230.27 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $446.68 Median $489.78 Typical High $501.19 | Professional | 53 · Discontinued | $446.68 | $489.78 | $501.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,659.59 Median $1,862.09 Typical High $1,862.09 | Professional | 54 · Surgery only | $1,659.59 | $1,862.09 | $1,862.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $331.13 Median $371.54 Typical High $371.54 | Professional | 55 · Aftercare only | $331.13 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $223.87 Median $245.47 Typical High $251.19 | Professional | 56 · Pre-op care only | $223.87 | $245.47 | $251.19 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $3,090.30 Median $4,786.30 Typical High $6,025.60 | Professional | 50 · Both sides | $3,090.30 | $4,786.30 | $6,025.60 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,122.02 Median $1,230.27 Typical High $1,230.27 | Professional | 52 · Reduced service | $1,122.02 | $1,230.27 | $1,230.27 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $446.68 Median $489.78 Typical High $501.19 | Professional | 53 · Discontinued | $446.68 | $489.78 | $501.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,659.59 Median $1,862.09 Typical High $1,862.09 | Professional | 54 · Surgery only | $1,659.59 | $1,862.09 | $1,862.09 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $331.13 Median $371.54 Typical High $371.54 | Professional | 55 · Aftercare only | $331.13 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $223.87 Median $245.47 Typical High $251.19 | Professional | 56 · Pre-op care only | $223.87 | $245.47 | $251.19 |
Where Pennsylvania sits
The same service costs 7.2 times more in Alabama than in Washington. 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.
Physician feeFacility fee
AL $19,737WA $2,745
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.