How much rates vary
Facilitymedian $813 · 10th to 90th $457 to $6,166Professionalmedian $1,175 · 10th to 90th $1,000 to $1,585
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 $1,096.48 Median $1,202.26 Typical High $1,258.93 | Professional | None | $1,096.48 | $1,202.26 | $1,258.93 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $851.14 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $758.58 | $851.14 | $870.96 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $22,387.21 Typical High $28,183.83 | Facility | None | $3,981.07 | $22,387.21 | $28,183.83 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,698.24 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,698.24 | $1,698.24 | $1,698.24 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $1,513.56 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $933.25 | $1,513.56 | $1,862.09 |
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 $1,000.00 Median $1,122.02 Typical High $2,290.87 | Professional | None | $1,000.00 | $1,122.02 | $2,290.87 |
Emblem Health Setting Professional Modifier None Typical Low $1,318.26 Median $1,778.28 Typical High $2,511.89 | Professional | None | $1,318.26 | $1,778.28 | $2,511.89 |
Geisinger Setting Professional Modifier None Typical Low $933.25 Median $1,174.90 Typical High $2,041.74 | Professional | None | $933.25 | $1,174.90 | $2,041.74 |
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 $1,096.48 Median $1,202.26 Typical High $1,258.93 | Professional | None | $1,096.48 | $1,202.26 | $1,258.93 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $851.14 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $758.58 | $851.14 | $870.96 |
Oscar Health Setting Professional Modifier None Typical Low $741.31 Median $776.25 Typical High $2,137.96 | Professional | None | $741.31 | $776.25 | $2,137.96 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,047.13 Median $4,365.16 Typical High $7,079.46 | Facility | None | $1,047.13 | $4,365.16 | $7,079.46 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,047.13 Median $1,148.15 Typical High $1,148.15 | Professional | None | $1,047.13 | $1,148.15 | $1,148.15 |
United Setting Facility Modifier None Typical Low $416.87 Median $707.95 Typical High $2,398.83 | Facility | None | $416.87 | $707.95 | $2,398.83 |
United Setting Professional Modifier None Typical Low $1,023.29 Median $1,202.26 Typical High $1,905.46 | Professional | None | $1,023.29 | $1,202.26 | $1,905.46 |
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 $549.54 Median $602.56 Typical High $630.96 | Professional | 52 · Reduced service | $549.54 | $602.56 | $630.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $218.78 Median $239.88 Typical High $251.19 | Professional | 53 · Discontinued | $218.78 | $239.88 | $251.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $912.01 Typical High $933.25 | Professional | 54 · Surgery only | $812.83 | $912.01 | $933.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $181.97 Typical High $186.21 | Professional | 55 · Aftercare only | $165.96 | $181.97 | $186.21 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $120.23 Typical High $125.89 | Professional | 56 · Pre-op care only | $109.65 | $120.23 | $125.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $549.54 Median $602.56 Typical High $630.96 | Professional | 52 · Reduced service | $549.54 | $602.56 | $630.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $218.78 Median $239.88 Typical High $251.19 | Professional | 53 · Discontinued | $218.78 | $239.88 | $251.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $912.01 Typical High $933.25 | Professional | 54 · Surgery only | $812.83 | $912.01 | $933.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $181.97 Typical High $186.21 | Professional | 55 · Aftercare only | $165.96 | $181.97 | $186.21 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $120.23 Typical High $125.89 | Professional | 56 · Pre-op care only | $109.65 | $120.23 | $125.89 |
Where Pennsylvania sits
The same service costs 5.5 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
$1,175
AK $4,266TX $776
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.