How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,000 · 10th to 90th $832 to $1,820
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 $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | None | $831.76 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $707.95 Typical High $707.95 | Professional | 78 · Unplanned return to OR | $588.84 | $707.95 | $707.95 |
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 $954.99 Median $1,513.56 Typical High $1,862.09 | Professional | None | $954.99 | $1,513.56 | $1,862.09 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $1,258.93 Typical High $1,548.82 | Professional | 78 · Unplanned return to OR | $794.33 | $1,258.93 | $1,548.82 |
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 $891.25 Median $1,000.00 Typical High $1,819.70 | Professional | None | $891.25 | $1,000.00 | $1,819.70 |
Emblem Health Setting Professional Modifier None Typical Low $1,348.96 Median $1,348.96 Typical High $1,445.44 | Professional | None | $1,348.96 | $1,348.96 | $1,445.44 |
Geisinger Setting Professional Modifier None Typical Low $870.96 Median $1,174.90 Typical High $1,862.09 | Professional | None | $870.96 | $1,174.90 | $1,862.09 |
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 $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | None | $831.76 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $707.95 Typical High $707.95 | Professional | 78 · Unplanned return to OR | $588.84 | $707.95 | $707.95 |
Oscar Health Setting Professional Modifier None Typical Low $1,071.52 Median $1,202.26 Typical High $2,089.30 | Professional | None | $1,071.52 | $1,202.26 | $2,089.30 |
UPMC Health Plan Setting Facility Modifier None Typical Low $912.01 Median $1,096.48 Typical High $1,096.48 | Facility | None | $912.01 | $1,096.48 | $1,096.48 |
UPMC Health Plan Setting Professional Modifier None Typical Low $912.01 Median $1,096.48 Typical High $1,096.48 | Professional | None | $912.01 | $1,096.48 | $1,096.48 |
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 $891.25 Median $1,122.02 Typical High $1,905.46 | Professional | None | $891.25 | $1,122.02 | $1,905.46 |
11 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 $416.87 Median $501.19 Typical High $501.19 | Professional | 52 · Reduced service | $416.87 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $204.17 Typical High $204.17 | Professional | 53 · Discontinued | $169.82 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $758.58 Typical High $758.58 | Professional | 54 · Surgery only | $630.96 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $151.36 Typical High $151.36 | Professional | 55 · Aftercare only | $125.89 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $100.00 Typical High $100.00 | Professional | 56 · Pre-op care only | $83.18 | $100.00 | $100.00 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,412.54 Median $2,238.72 Typical High $2,818.38 | Professional | 50 · Both sides | $1,412.54 | $2,238.72 | $2,818.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $416.87 Median $501.19 Typical High $501.19 | Professional | 52 · Reduced service | $416.87 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $204.17 Typical High $204.17 | Professional | 53 · Discontinued | $169.82 | $204.17 | $204.17 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $758.58 Typical High $758.58 | Professional | 54 · Surgery only | $630.96 | $758.58 | $758.58 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $151.36 Typical High $151.36 | Professional | 55 · Aftercare only | $125.89 | $151.36 | $151.36 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $100.00 Typical High $100.00 | Professional | 56 · Pre-op care only | $83.18 | $100.00 | $100.00 |
Where Pennsylvania sits
The same service costs 7.9 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· 42nd of 51
$1,000
AK $3,802TX $479
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.