How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $5,012 · 10th to 90th $4,074 to $6,607
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 $5,248.07 Typical High $8,511.38 | Facility | None | $831.76 | $5,248.07 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $4,570.88 Median $5,128.61 Typical High $5,248.07 | Professional | None | $4,570.88 | $5,128.61 | $5,248.07 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,235.94 Median $3,548.13 Typical High $3,630.78 | Professional | 78 · Unplanned return to OR | $3,235.94 | $3,548.13 | $3,630.78 |
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 $7,244.36 Median $7,244.36 Typical High $7,244.36 | Professional | None | $7,244.36 | $7,244.36 | $7,244.36 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,981.07 Median $6,309.57 Typical High $8,128.31 | Professional | 78 · Unplanned return to OR | $3,981.07 | $6,309.57 | $8,128.31 |
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 $4,073.80 Median $4,786.30 Typical High $9,772.37 | Professional | None | $4,073.80 | $4,786.30 | $9,772.37 |
Emblem Health Setting Professional Modifier None Typical Low $5,495.41 Median $7,413.10 Typical High $10,232.93 | Professional | None | $5,495.41 | $7,413.10 | $10,232.93 |
Geisinger Setting Professional Modifier None Typical Low $4,570.88 Median $5,754.40 Typical High $9,120.11 | Professional | None | $4,570.88 | $5,754.40 | $9,120.11 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $5,248.07 Typical High $8,709.64 | Facility | None | $831.76 | $5,248.07 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $4,570.88 Median $5,128.61 Typical High $5,248.07 | Professional | None | $4,570.88 | $5,128.61 | $5,248.07 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,235.94 Median $3,548.13 Typical High $3,630.78 | Professional | 78 · Unplanned return to OR | $3,235.94 | $3,548.13 | $3,630.78 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $2,454.71 Typical High $9,332.54 | Professional | None | $15.14 | $2,454.71 | $9,332.54 |
UPMC Health Plan Setting Facility Modifier None Typical Low $4,786.30 Median $5,011.87 Typical High $5,011.87 | Facility | None | $4,786.30 | $5,011.87 | $5,011.87 |
UPMC Health Plan Setting Professional Modifier None Typical Low $4,786.30 Median $4,897.79 Typical High $5,011.87 | Professional | None | $4,786.30 | $4,897.79 | $5,011.87 |
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 $4,265.80 Median $5,128.61 Typical High $8,128.31 | Professional | None | $4,265.80 | $5,128.61 | $8,128.31 |
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 $2,290.87 Median $2,570.40 Typical High $2,630.27 | Professional | 52 · Reduced service | $2,290.87 | $2,570.40 | $2,630.27 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $912.01 Median $1,023.29 Typical High $1,047.13 | Professional | 53 · Discontinued | $912.01 | $1,023.29 | $1,047.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3,467.37 Median $3,801.89 Typical High $3,890.45 | Professional | 54 · Surgery only | $3,467.37 | $3,801.89 | $3,890.45 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $691.83 Median $758.58 Typical High $776.25 | Professional | 55 · Aftercare only | $691.83 | $758.58 | $776.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $457.09 Median $512.86 Typical High $524.81 | Professional | 56 · Pre-op care only | $457.09 | $512.86 | $524.81 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2,290.87 Median $2,570.40 Typical High $2,630.27 | Professional | 52 · Reduced service | $2,290.87 | $2,570.40 | $2,630.27 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $912.01 Median $1,023.29 Typical High $1,047.13 | Professional | 53 · Discontinued | $912.01 | $1,023.29 | $1,047.13 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $3,467.37 Median $3,801.89 Typical High $3,890.45 | Professional | 54 · Surgery only | $3,467.37 | $3,801.89 | $3,890.45 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $691.83 Median $758.58 Typical High $776.25 | Professional | 55 · Aftercare only | $691.83 | $758.58 | $776.25 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $457.09 Median $512.86 Typical High $524.81 | Professional | 56 · Pre-op care only | $457.09 | $512.86 | $524.81 |
Where Pennsylvania sits
The same service costs 21.9 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· 40th of 51
$4,898
AK $16,596TX $759
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.