How much rates vary
Facilitymedian $891 · 10th to 90th $240 to $7,244Professionalmedian $3,802 · 10th to 90th $3,311 to $6,918
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 $3,311.31 Median $3,715.35 Typical High $3,801.89 | Professional | None | $3,311.31 | $3,715.35 | $3,801.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,344.23 Median $2,570.40 Typical High $2,630.27 | Professional | 78 · Unplanned return to OR | $2,344.23 | $2,570.40 | $2,630.27 |
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 $3,548.13 Median $5,754.40 Typical High $7,079.46 | Professional | None | $3,548.13 | $5,754.40 | $7,079.46 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,884.03 Median $4,570.88 Typical High $5,754.40 | Professional | 78 · Unplanned return to OR | $2,884.03 | $4,570.88 | $5,754.40 |
Cigna Setting Professional Modifier None Typical Low $9,772.37 Median $9,772.37 Typical High $10,715.19 | Professional | None | $9,772.37 | $9,772.37 | $10,715.19 |
Emblem Health Setting Professional Modifier None Typical Low $3,981.07 Median $5,370.32 Typical High $7,585.78 | Professional | None | $3,981.07 | $5,370.32 | $7,585.78 |
Geisinger Setting Professional Modifier None Typical Low $3,162.28 Median $3,630.78 Typical High $6,309.57 | Professional | None | $3,162.28 | $3,630.78 | $6,309.57 |
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 $3,311.31 Median $3,715.35 Typical High $3,801.89 | Professional | None | $3,311.31 | $3,715.35 | $3,801.89 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,344.23 Median $2,570.40 Typical High $2,630.27 | Professional | 78 · Unplanned return to OR | $2,344.23 | $2,570.40 | $2,630.27 |
Oscar Health Setting Professional Modifier None Typical Low $12.88 Median $3,388.44 Typical High $6,606.93 | Professional | None | $12.88 | $3,388.44 | $6,606.93 |
UPMC Health Plan Setting Facility Modifier None Typical Low $3,090.30 Median $3,090.30 Typical High $3,467.37 | Facility | None | $3,090.30 | $3,090.30 | $3,467.37 |
UPMC Health Plan Setting Professional Modifier None Typical Low $3,090.30 Median $3,467.37 Typical High $3,548.13 | Professional | None | $3,090.30 | $3,467.37 | $3,548.13 |
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 $3,090.30 Median $3,630.78 Typical High $5,754.40 | Professional | None | $3,090.30 | $3,630.78 | $5,754.40 |
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 $1,659.59 Median $1,862.09 Typical High $1,905.46 | Professional | 52 · Reduced service | $1,659.59 | $1,862.09 | $1,905.46 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $660.69 Median $741.31 Typical High $758.58 | Professional | 53 · Discontinued | $660.69 | $741.31 | $758.58 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,511.89 Median $2,754.23 Typical High $2,818.38 | Professional | 54 · Surgery only | $2,511.89 | $2,754.23 | $2,818.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $501.19 Median $549.54 Typical High $575.44 | Professional | 55 · Aftercare only | $501.19 | $549.54 | $575.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $331.13 Median $371.54 Typical High $380.19 | Professional | 56 · Pre-op care only | $331.13 | $371.54 | $380.19 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,659.59 Median $1,862.09 Typical High $1,905.46 | Professional | 52 · Reduced service | $1,659.59 | $1,862.09 | $1,905.46 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $660.69 Median $741.31 Typical High $758.58 | Professional | 53 · Discontinued | $660.69 | $741.31 | $758.58 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,511.89 Median $2,754.23 Typical High $2,818.38 | Professional | 54 · Surgery only | $2,511.89 | $2,754.23 | $2,818.38 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $501.19 Median $549.54 Typical High $575.44 | Professional | 55 · Aftercare only | $501.19 | $549.54 | $575.44 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $331.13 Median $371.54 Typical High $380.19 | Professional | 56 · Pre-op care only | $331.13 | $371.54 | $380.19 |
Where Pennsylvania sits
The same service costs 27.5 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· 36th of 51
$3,802
AK $14,454TX $525
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.