How much rates vary
Facilitymedian $1,995 · 10th to 90th $575 to $6,310Professionalmedian $1,318 · 10th to 90th $1,122 to $1,738
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 $1,202.26 Median $1,318.26 Typical High $1,380.38 | Professional | None | $1,202.26 | $1,318.26 | $1,380.38 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $933.25 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $851.14 | $933.25 | $954.99 |
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 $1,862.09 Median $1,862.09 Typical High $1,862.09 | Professional | None | $1,862.09 | $1,862.09 | $1,862.09 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,659.59 Typical High $2,089.30 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,659.59 | $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 $1,122.02 Median $1,230.27 Typical High $2,511.89 | Professional | None | $1,122.02 | $1,230.27 | $2,511.89 |
Emblem Health Setting Professional Modifier None Typical Low $1,445.44 Median $1,949.84 Typical High $2,691.53 | Professional | None | $1,445.44 | $1,949.84 | $2,691.53 |
Geisinger Setting Professional Modifier None Typical Low $1,148.15 Median $1,288.25 Typical High $2,344.23 | Professional | None | $1,148.15 | $1,288.25 | $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 $1,202.26 Median $1,348.96 Typical High $1,380.38 | Professional | None | $1,202.26 | $1,348.96 | $1,380.38 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $933.25 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $851.14 | $933.25 | $954.99 |
Oscar Health Setting Professional Modifier None Typical Low $10.96 Median $1,202.26 Typical High $2,398.83 | Professional | None | $10.96 | $1,202.26 | $2,398.83 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,258.93 Median $1,348.96 Typical High $1,348.96 | Facility | None | $1,258.93 | $1,348.96 | $1,348.96 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,258.93 Median $1,288.25 Typical High $1,348.96 | Professional | None | $1,258.93 | $1,288.25 | $1,348.96 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,398.83 Typical High $5,011.87 | Facility | None | $1,380.38 | $2,398.83 | $5,011.87 |
United Setting Professional Modifier None Typical Low $1,122.02 Median $1,318.26 Typical High $2,089.30 | Professional | None | $1,122.02 | $1,318.26 | $2,089.30 |
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 $602.56 Median $660.69 Typical High $691.83 | Professional | 52 · Reduced service | $602.56 | $660.69 | $691.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $269.15 Typical High $275.42 | Professional | 53 · Discontinued | $239.88 | $269.15 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $1,000.00 Typical High $1,023.29 | Professional | 54 · Surgery only | $912.01 | $1,000.00 | $1,023.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $199.53 Typical High $204.17 | Professional | 55 · Aftercare only | $181.97 | $199.53 | $204.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $134.90 Typical High $138.04 | Professional | 56 · Pre-op care only | $120.23 | $134.90 | $138.04 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $602.56 Median $660.69 Typical High $691.83 | Professional | 52 · Reduced service | $602.56 | $660.69 | $691.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $269.15 Typical High $275.42 | Professional | 53 · Discontinued | $239.88 | $269.15 | $275.42 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $1,000.00 Typical High $1,023.29 | Professional | 54 · Surgery only | $912.01 | $1,000.00 | $1,023.29 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $199.53 Typical High $204.17 | Professional | 55 · Aftercare only | $181.97 | $199.53 | $204.17 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $134.90 Typical High $138.04 | Professional | 56 · Pre-op care only | $120.23 | $134.90 | $138.04 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $1,122.02 Median $1,122.02 Typical High $1,122.02 | Professional | 62 · Two surgeons | $1,122.02 | $1,122.02 | $1,122.02 |
Where Pennsylvania sits
The same service costs 26.3 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 $5,248TX $200
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.