How much rates vary
Facilitymedian $5,495 · 10th to 90th $646 to $12,303Professionalmedian $5,623 · 10th to 90th $437 to $12,303
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 $724.44 Median $5,754.40 Typical High $10,000.00 | Facility | None | $724.44 | $5,754.40 | $10,000.00 |
Aetna Setting Professional Modifier None Typical Low $416.87 Median $1,318.26 Typical High $6,760.83 | Professional | None | $416.87 | $1,318.26 | $6,760.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $1,737.80 Typical High $4,677.35 | Professional | 78 · Unplanned return to OR | $288.40 | $1,737.80 | $4,677.35 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $12,022.64 Typical High $56,234.13 | Facility | None | $3,981.07 | $12,022.64 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $5,370.32 Median $10,471.29 Typical High $14,125.38 | Professional | None | $5,370.32 | $10,471.29 | $14,125.38 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $4,365.16 Median $8,317.64 Typical High $11,481.54 | Professional | 78 · Unplanned return to OR | $4,365.16 | $8,317.64 | $11,481.54 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $6,760.83 Typical High $12,302.69 | Facility | None | $501.19 | $6,760.83 | $12,302.69 |
Cigna Setting Professional Modifier None Typical Low $426.58 Median $4,265.80 Typical High $8,511.38 | Professional | None | $426.58 | $4,265.80 | $8,511.38 |
Emblem Health Setting Professional Modifier None Typical Low $6,760.83 Median $9,772.37 Typical High $12,882.50 | Professional | None | $6,760.83 | $9,772.37 | $12,882.50 |
Geisinger Setting Facility Modifier None Typical Low $7,413.10 Median $9,332.54 Typical High $16,218.10 | Facility | None | $7,413.10 | $9,332.54 | $16,218.10 |
Geisinger Setting Professional Modifier None Typical Low $549.54 Median $7,585.78 Typical High $10,000.00 | Professional | None | $549.54 | $7,585.78 | $10,000.00 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $5,248.07 Typical High $10,000.00 | Facility | None | $831.76 | $5,248.07 | $10,000.00 |
Martin's Point Setting Professional Modifier None Typical Low $416.87 Median $1,318.26 Typical High $6,760.83 | Professional | None | $416.87 | $1,318.26 | $6,760.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $1,737.80 Typical High $4,677.35 | Professional | 78 · Unplanned return to OR | $288.40 | $1,737.80 | $4,677.35 |
Oscar Health Setting Professional Modifier None Typical Low $6,606.93 Median $10,471.29 Typical High $23,988.33 | Professional | None | $6,606.93 | $10,471.29 | $23,988.33 |
UPMC Health Plan Setting Facility Modifier None Typical Low $436.52 Median $537.03 Typical High $7,943.28 | Facility | None | $436.52 | $537.03 | $7,943.28 |
UPMC Health Plan Setting Professional Modifier None Typical Low $436.52 Median $5,623.41 Typical High $7,943.28 | Professional | None | $436.52 | $5,623.41 | $7,943.28 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,235.94 Typical High $10,715.19 | Facility | None | $1,698.24 | $3,235.94 | $10,715.19 |
United Setting Professional Modifier None Typical Low $398.11 Median $4,168.69 Typical High $9,120.11 | Professional | None | $398.11 | $4,168.69 | $9,120.11 |
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 $204.17 Median $1,230.27 Typical High $3,388.44 | Professional | 52 · Reduced service | $204.17 | $1,230.27 | $3,388.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $489.78 Typical High $1,348.96 | Professional | 53 · Discontinued | $83.18 | $489.78 | $1,348.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $1,862.09 Typical High $5,011.87 | Professional | 54 · Surgery only | $309.03 | $1,862.09 | $5,011.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $371.54 Typical High $1,000.00 | Professional | 55 · Aftercare only | $61.66 | $371.54 | $1,000.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $245.47 Typical High $676.08 | Professional | 56 · Pre-op care only | $41.69 | $245.47 | $676.08 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $204.17 Median $1,230.27 Typical High $3,388.44 | Professional | 52 · Reduced service | $204.17 | $1,230.27 | $3,388.44 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $489.78 Typical High $1,348.96 | Professional | 53 · Discontinued | $83.18 | $489.78 | $1,348.96 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $1,862.09 Typical High $5,011.87 | Professional | 54 · Surgery only | $309.03 | $1,862.09 | $5,011.87 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $371.54 Typical High $1,000.00 | Professional | 55 · Aftercare only | $61.66 | $371.54 | $1,000.00 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $245.47 Typical High $676.08 | Professional | 56 · Pre-op care only | $41.69 | $245.47 | $676.08 |
Where Pennsylvania sits
The same service costs 4.1 times more in Iowa than in Delaware. 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.
Physician feeFacility fee
IA $18,453DE $4,539
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.