How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,318 · 10th to 90th $1,175 to $1,820
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 $1,230.27 Median $1,348.96 Typical High $1,380.38 | Professional | None | $1,230.27 | $1,348.96 | $1,380.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $954.99 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $851.14 | $954.99 | $977.24 |
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 $1,905.46 Median $1,905.46 Typical High $1,905.46 | Professional | None | $1,905.46 | $1,905.46 | $1,905.46 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,698.24 Typical High $2,089.30 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,698.24 | $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 $1,230.27 Median $1,258.93 Typical High $2,570.40 | Professional | None | $1,230.27 | $1,258.93 | $2,570.40 |
Emblem Health Setting Professional Modifier None Typical Low $1,513.56 Median $2,041.74 Typical High $2,691.53 | Professional | None | $1,513.56 | $2,041.74 | $2,691.53 |
Geisinger 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 |
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 $1,230.27 Median $1,348.96 Typical High $1,380.38 | Professional | None | $1,230.27 | $1,348.96 | $1,380.38 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $954.99 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $851.14 | $954.99 | $977.24 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $1,148.15 Typical High $2,630.27 | Professional | None | $15.14 | $1,148.15 | $2,630.27 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,096.48 Median $1,096.48 Typical High $1,288.25 | Facility | None | $1,096.48 | $1,096.48 | $1,288.25 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,096.48 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,096.48 | $1,288.25 | $1,288.25 |
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 $1,174.90 Median $1,348.96 Typical High $2,137.96 | Professional | None | $1,174.90 | $1,348.96 | $2,137.96 |
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 $616.60 Median $676.08 Typical High $691.83 | Professional | 52 · Reduced service | $616.60 | $676.08 | $691.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $269.15 Typical High $275.42 | Professional | 53 · Discontinued | $245.47 | $269.15 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $1,023.29 Typical High $1,047.13 | Professional | 54 · Surgery only | $912.01 | $1,023.29 | $1,047.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $204.17 Typical High $208.93 | Professional | 55 · Aftercare only | $181.97 | $204.17 | $208.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $134.90 Typical High $138.04 | Professional | 56 · Pre-op care only | $123.03 | $134.90 | $138.04 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $616.60 Median $676.08 Typical High $691.83 | Professional | 52 · Reduced service | $616.60 | $676.08 | $691.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $269.15 Typical High $275.42 | Professional | 53 · Discontinued | $245.47 | $269.15 | $275.42 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $1,023.29 Typical High $1,047.13 | Professional | 54 · Surgery only | $912.01 | $1,023.29 | $1,047.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $204.17 Typical High $208.93 | Professional | 55 · Aftercare only | $181.97 | $204.17 | $208.93 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $134.90 Typical High $138.04 | Professional | 56 · Pre-op care only | $123.03 | $134.90 | $138.04 |
Where Pennsylvania sits
The same service costs 21.4 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· 40th of 51
$1,288
AK $4,571TX $214
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.