How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $4,169 · 10th to 90th $3,311 to $5,623
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 $3,981.07 Median $4,365.16 Typical High $4,466.84 | Professional | None | $3,981.07 | $4,365.16 | $4,466.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,754.23 Median $3,090.30 Typical High $3,162.28 | Professional | 78 · Unplanned return to OR | $2,754.23 | $3,090.30 | $3,162.28 |
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 $6,165.95 Median $6,165.95 Typical High $6,165.95 | Professional | None | $6,165.95 | $6,165.95 | $6,165.95 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,388.44 Median $5,495.41 Typical High $6,456.54 | Professional | 78 · Unplanned return to OR | $3,388.44 | $5,495.41 | $6,456.54 |
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 $3,311.31 Median $4,073.80 Typical High $7,762.47 | Professional | None | $3,311.31 | $4,073.80 | $7,762.47 |
Emblem Health Setting Professional Modifier None Typical Low $4,677.35 Median $6,309.57 Typical High $8,317.64 | Professional | None | $4,677.35 | $6,309.57 | $8,317.64 |
Geisinger Setting Professional Modifier None Typical Low $3,548.13 Median $4,168.69 Typical High $7,079.46 | Professional | None | $3,548.13 | $4,168.69 | $7,079.46 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $4,466.84 Typical High $8,709.64 | Facility | None | $831.76 | $4,466.84 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $3,981.07 Median $4,365.16 Typical High $4,466.84 | Professional | None | $3,981.07 | $4,365.16 | $4,466.84 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,754.23 Median $3,090.30 Typical High $3,162.28 | Professional | 78 · Unplanned return to OR | $2,754.23 | $3,090.30 | $3,162.28 |
Oscar Health Setting Professional Modifier None Typical Low $2,884.03 Median $3,019.95 Typical High $7,762.47 | Professional | None | $2,884.03 | $3,019.95 | $7,762.47 |
UPMC Health Plan Setting Facility Modifier None Typical Low $3,467.37 Median $3,467.37 Typical High $4,168.69 | Facility | None | $3,467.37 | $3,467.37 | $4,168.69 |
UPMC Health Plan Setting Professional Modifier None Typical Low $3,467.37 Median $4,168.69 Typical High $4,168.69 | Professional | None | $3,467.37 | $4,168.69 | $4,168.69 |
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 $3,715.35 Median $4,365.16 Typical High $6,918.31 | Professional | None | $3,715.35 | $4,365.16 | $6,918.31 |
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 $1,995.26 Median $2,187.76 Typical High $2,238.72 | Professional | 52 · Reduced service | $1,995.26 | $2,187.76 | $2,238.72 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $794.33 Median $870.96 Typical High $891.25 | Professional | 53 · Discontinued | $794.33 | $870.96 | $891.25 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,951.21 Median $3,311.31 Typical High $3,388.44 | Professional | 54 · Surgery only | $2,951.21 | $3,311.31 | $3,388.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $588.84 Median $660.69 Typical High $676.08 | Professional | 55 · Aftercare only | $588.84 | $660.69 | $676.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $398.11 Median $436.52 Typical High $446.68 | Professional | 56 · Pre-op care only | $398.11 | $436.52 | $446.68 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,995.26 Median $2,187.76 Typical High $2,238.72 | Professional | 52 · Reduced service | $1,995.26 | $2,187.76 | $2,238.72 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $794.33 Median $870.96 Typical High $891.25 | Professional | 53 · Discontinued | $794.33 | $870.96 | $891.25 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,951.21 Median $3,311.31 Typical High $3,388.44 | Professional | 54 · Surgery only | $2,951.21 | $3,311.31 | $3,388.44 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $588.84 Median $660.69 Typical High $676.08 | Professional | 55 · Aftercare only | $588.84 | $660.69 | $676.08 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $398.11 Median $436.52 Typical High $446.68 | Professional | 56 · Pre-op care only | $398.11 | $436.52 | $446.68 |
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· 38th of 51
$4,169
AK $14,125TX $646
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.