How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,318 · 10th to 90th $1,148 to $1,778
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 $1,412.54 | Professional | None | $1,230.27 | $1,348.96 | $1,412.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $954.99 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $870.96 | $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 $2,137.96 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,698.24 | $2,137.96 |
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 $1,148.15 Median $1,258.93 Typical High $2,570.40 | Professional | None | $1,148.15 | $1,258.93 | $2,570.40 |
Emblem Health Setting Professional Modifier None Typical Low $1,479.11 Median $1,995.26 Typical High $2,754.23 | Professional | None | $1,479.11 | $1,995.26 | $2,754.23 |
Geisinger Setting Professional Modifier None Typical Low $1,122.02 Median $1,318.26 Typical High $2,344.23 | Professional | None | $1,122.02 | $1,318.26 | $2,344.23 |
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 $1,230.27 Median $1,348.96 Typical High $1,412.54 | Professional | None | $1,230.27 | $1,348.96 | $1,412.54 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $954.99 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $870.96 | $954.99 | $977.24 |
Oscar Health Setting Professional Modifier None Typical Low $1,071.52 Median $1,122.02 Typical High $2,454.71 | Professional | None | $1,071.52 | $1,122.02 | $2,454.71 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,202.26 Median $1,202.26 Typical High $1,288.25 | Facility | None | $1,202.26 | $1,202.26 | $1,288.25 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,202.26 Median $1,288.25 Typical High $1,318.26 | Professional | None | $1,202.26 | $1,288.25 | $1,318.26 |
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 $1,348.96 Typical High $2,137.96 | Professional | None | $1,148.15 | $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 $707.95 | Professional | 52 · Reduced service | $616.60 | $676.08 | $707.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $275.42 Typical High $281.84 | Professional | 53 · Discontinued | $245.47 | $275.42 | $281.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $1,023.29 Typical High $1,047.13 | Professional | 54 · Surgery only | $933.25 | $1,023.29 | $1,047.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $204.17 Typical High $208.93 | Professional | 55 · Aftercare only | $186.21 | $204.17 | $208.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $134.90 Typical High $141.25 | Professional | 56 · Pre-op care only | $123.03 | $134.90 | $141.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $616.60 Median $676.08 Typical High $707.95 | Professional | 52 · Reduced service | $616.60 | $676.08 | $707.95 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $275.42 Typical High $281.84 | Professional | 53 · Discontinued | $245.47 | $275.42 | $281.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $1,023.29 Typical High $1,047.13 | Professional | 54 · Surgery only | $933.25 | $1,023.29 | $1,047.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $204.17 Typical High $208.93 | Professional | 55 · Aftercare only | $186.21 | $204.17 | $208.93 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $134.90 Typical High $141.25 | Professional | 56 · Pre-op care only | $123.03 | $134.90 | $141.25 |
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· 40th of 51
$1,318
AK $4,571TX $851
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.