How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,318 · 10th to 90th $1,148 to $2,239
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 $1,258.93 Median $1,380.38 Typical High $1,412.54 | Professional | None | $1,258.93 | $1,380.38 | $1,412.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $977.24 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $870.96 | $977.24 | $1,000.00 |
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 $2,238.72 Median $2,238.72 Typical High $2,238.72 | Professional | None | $2,238.72 | $2,238.72 | $2,238.72 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,737.80 Typical High $2,137.96 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,737.80 | $2,137.96 |
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 $1,148.15 Median $1,288.25 Typical High $2,630.27 | Professional | None | $1,148.15 | $1,288.25 | $2,630.27 |
Emblem Health Setting Professional Modifier None Typical Low $1,479.11 Median $2,041.74 Typical High $2,818.38 | Professional | None | $1,479.11 | $2,041.74 | $2,818.38 |
Geisinger Setting Professional Modifier None Typical Low $1,122.02 Median $1,348.96 Typical High $2,344.23 | Professional | None | $1,122.02 | $1,348.96 | $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 $1,258.93 Median $1,348.96 Typical High $1,412.54 | Professional | None | $1,258.93 | $1,348.96 | $1,412.54 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $977.24 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $870.96 | $977.24 | $1,000.00 |
Oscar Health Setting Professional Modifier None Typical Low $1,122.02 Median $1,174.90 Typical High $2,454.71 | Professional | None | $1,122.02 | $1,174.90 | $2,454.71 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,047.13 Median $1,047.13 Typical High $1,288.25 | Facility | None | $1,047.13 | $1,047.13 | $1,288.25 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,047.13 Median $1,288.25 Typical High $1,318.26 | Professional | None | $1,047.13 | $1,288.25 | $1,318.26 |
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 $1,174.90 Median $1,380.38 Typical High $2,187.76 | Professional | None | $1,174.90 | $1,380.38 | $2,187.76 |
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 $630.96 Median $691.83 Typical High $707.95 | Professional | 52 · Reduced service | $630.96 | $691.83 | $707.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $275.42 Typical High $281.84 | Professional | 53 · Discontinued | $251.19 | $275.42 | $281.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $1,047.13 Typical High $1,071.52 | Professional | 54 · Surgery only | $933.25 | $1,047.13 | $1,071.52 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $208.93 Typical High $213.80 | Professional | 55 · Aftercare only | $186.21 | $208.93 | $213.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $138.04 Typical High $141.25 | Professional | 56 · Pre-op care only | $125.89 | $138.04 | $141.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $630.96 Median $691.83 Typical High $707.95 | Professional | 52 · Reduced service | $630.96 | $691.83 | $707.95 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $275.42 Typical High $281.84 | Professional | 53 · Discontinued | $251.19 | $275.42 | $281.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $1,047.13 Typical High $1,071.52 | Professional | 54 · Surgery only | $933.25 | $1,047.13 | $1,071.52 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $208.93 Typical High $213.80 | Professional | 55 · Aftercare only | $186.21 | $208.93 | $213.80 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $138.04 Typical High $141.25 | Professional | 56 · Pre-op care only | $125.89 | $138.04 | $141.25 |
Where Pennsylvania sits
The same service costs 5.0 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 $4,467TX $891
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.