How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,549 · 10th to 90th $1,318 to $2,455
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 $1,318.26 Median $1,584.89 Typical High $1,621.81 | Professional | None | $1,318.26 | $1,584.89 | $1,621.81 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $1,122.02 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $933.25 | $1,122.02 | $1,122.02 |
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 $2,344.23 Median $2,344.23 Typical High $56,234.13 | Professional | None | $2,344.23 | $2,344.23 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,230.27 Median $1,949.84 Typical High $2,344.23 | Professional | 78 · Unplanned return to OR | $1,230.27 | $1,949.84 | $2,344.23 |
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 $1,288.25 Median $1,513.56 Typical High $2,818.38 | Professional | None | $1,288.25 | $1,513.56 | $2,818.38 |
Emblem Health Setting Professional Modifier None Typical Low $2,187.76 Median $2,187.76 Typical High $2,454.71 | Professional | None | $2,187.76 | $2,187.76 | $2,454.71 |
Geisinger Setting Professional Modifier None Typical Low $1,318.26 Median $1,778.28 Typical High $2,951.21 | Professional | None | $1,318.26 | $1,778.28 | $2,951.21 |
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 $1,318.26 Median $1,584.89 Typical High $1,621.81 | Professional | None | $1,318.26 | $1,584.89 | $1,621.81 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $1,122.02 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $933.25 | $1,122.02 | $1,122.02 |
Oscar Health Setting Professional Modifier None Typical Low $1,621.81 Median $1,698.24 Typical High $2,818.38 | Professional | None | $1,621.81 | $1,698.24 | $2,818.38 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,445.44 Median $1,479.11 Typical High $1,479.11 | Facility | None | $1,445.44 | $1,479.11 | $1,479.11 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,445.44 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,445.44 | $1,479.11 | $1,479.11 |
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 $1,318.26 Median $1,698.24 Typical High $2,951.21 | Professional | None | $1,318.26 | $1,698.24 | $2,951.21 |
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 $660.69 Median $794.33 Typical High $812.83 | Professional | 52 · Reduced service | $660.69 | $794.33 | $812.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $316.23 Typical High $323.59 | Professional | 53 · Discontinued | $263.03 | $316.23 | $323.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,202.26 Typical High $1,202.26 | Professional | 54 · Surgery only | $1,000.00 | $1,202.26 | $1,202.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $239.88 Typical High $245.47 | Professional | 55 · Aftercare only | $199.53 | $239.88 | $245.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $158.49 Typical High $162.18 | Professional | 56 · Pre-op care only | $131.83 | $158.49 | $162.18 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $660.69 Median $794.33 Typical High $812.83 | Professional | 52 · Reduced service | $660.69 | $794.33 | $812.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $316.23 Typical High $323.59 | Professional | 53 · Discontinued | $263.03 | $316.23 | $323.59 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,202.26 Typical High $1,202.26 | Professional | 54 · Surgery only | $1,000.00 | $1,202.26 | $1,202.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $239.88 Typical High $245.47 | Professional | 55 · Aftercare only | $199.53 | $239.88 | $245.47 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $158.49 Typical High $162.18 | Professional | 56 · Pre-op care only | $131.83 | $158.49 | $162.18 |
Where Pennsylvania sits
The same service costs 5.6 times more in Alaska than in Utah. 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· 45th of 51
$1,514
AK $6,026UT $1,072
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.