How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,445 · 10th to 90th $1,175 to $2,399
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 $1,318.26 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,318.26 | $1,445.44 | $1,445.44 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $1,023.29 Typical High $1,023.29 | Professional | 78 · Unplanned return to OR | $912.01 | $1,023.29 | $1,023.29 |
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 $1,202.26 Median $1,949.84 Typical High $2,511.89 | Professional | None | $1,202.26 | $1,949.84 | $2,511.89 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $1,621.81 Typical High $2,089.30 | Professional | 78 · Unplanned return to OR | $1,023.29 | $1,621.81 | $2,089.30 |
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 $1,174.90 Median $1,380.38 Typical High $2,454.71 | Professional | None | $1,174.90 | $1,380.38 | $2,454.71 |
Emblem Health Setting Professional Modifier None Typical Low $1,737.80 Median $1,737.80 Typical High $1,995.26 | Professional | None | $1,737.80 | $1,737.80 | $1,995.26 |
Geisinger Setting Professional Modifier None Typical Low $1,288.25 Median $1,659.59 Typical High $2,754.23 | Professional | None | $1,288.25 | $1,659.59 | $2,754.23 |
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 $1,318.26 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,318.26 | $1,445.44 | $1,445.44 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $1,023.29 Typical High $1,023.29 | Professional | 78 · Unplanned return to OR | $912.01 | $1,023.29 | $1,023.29 |
Oscar Health Setting Professional Modifier None Typical Low $2,691.53 Median $2,691.53 Typical High $2,691.53 | Professional | None | $2,691.53 | $2,691.53 | $2,691.53 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,174.90 Median $1,513.56 Typical High $1,513.56 | Facility | None | $1,174.90 | $1,513.56 | $1,513.56 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,174.90 Median $1,230.27 Typical High $1,513.56 | Professional | None | $1,174.90 | $1,230.27 | $1,513.56 |
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 $1,148.15 Median $1,584.89 Typical High $2,511.89 | Professional | None | $1,148.15 | $1,584.89 | $2,511.89 |
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 $660.69 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $660.69 | $724.44 | $724.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $288.40 Typical High $288.40 | Professional | 53 · Discontinued | $263.03 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $977.24 Median $1,096.48 Typical High $1,096.48 | Professional | 54 · Surgery only | $977.24 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $194.98 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $194.98 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $144.54 Typical High $144.54 | Professional | 56 · Pre-op care only | $131.83 | $144.54 | $144.54 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,819.70 Median $2,818.38 Typical High $3,715.35 | Professional | 50 · Both sides | $1,819.70 | $2,818.38 | $3,715.35 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $660.69 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $660.69 | $724.44 | $724.44 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $288.40 Typical High $288.40 | Professional | 53 · Discontinued | $263.03 | $288.40 | $288.40 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $977.24 Median $1,096.48 Typical High $1,096.48 | Professional | 54 · Surgery only | $977.24 | $1,096.48 | $1,096.48 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $194.98 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $194.98 | $218.78 | $218.78 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $144.54 Typical High $144.54 | Professional | 56 · Pre-op care only | $131.83 | $144.54 | $144.54 |
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· 39th of 51
$1,445
AK $4,898TX $912
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.