How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $955 · 10th to 90th $794 to $1,698
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 $794.33 Median $4,897.79 Typical High $8,511.38 | Facility | None | $794.33 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $794.33 Median $954.99 Typical High $954.99 | Professional | None | $794.33 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $660.69 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $549.54 | $660.69 | $660.69 |
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 $891.25 Median $1,412.54 Typical High $1,737.80 | Professional | None | $891.25 | $1,412.54 | $1,737.80 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $1,174.90 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $741.31 | $1,174.90 | $1,445.44 |
Cigna Setting Facility Modifier None Typical Low $380.19 Median $660.69 Typical High $2,290.87 | Facility | None | $380.19 | $660.69 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $831.76 Median $933.25 Typical High $1,698.24 | Professional | None | $831.76 | $933.25 | $1,698.24 |
Emblem Health Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,348.96 | Professional | None | $1,258.93 | $1,258.93 | $1,348.96 |
Geisinger Setting Professional Modifier None Typical Low $812.83 Median $1,096.48 Typical High $1,737.80 | Professional | None | $812.83 | $1,096.48 | $1,737.80 |
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 $794.33 Median $954.99 Typical High $954.99 | Professional | None | $794.33 | $954.99 | $954.99 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $660.69 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $549.54 | $660.69 | $660.69 |
Oscar Health Setting Professional Modifier None Typical Low $1,000.00 Median $1,122.02 Typical High $1,949.84 | Professional | None | $1,000.00 | $1,122.02 | $1,949.84 |
UPMC Health Plan Setting Facility Modifier None Typical Low $870.96 Median $1,023.29 Typical High $1,023.29 | Facility | None | $870.96 | $1,023.29 | $1,023.29 |
UPMC Health Plan Setting Professional Modifier None Typical Low $870.96 Median $1,023.29 Typical High $1,023.29 | Professional | None | $870.96 | $1,023.29 | $1,023.29 |
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 $831.76 Median $1,047.13 Typical High $1,778.28 | Professional | None | $831.76 | $1,047.13 | $1,778.28 |
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 $389.05 Median $478.63 Typical High $478.63 | Professional | 52 · Reduced service | $389.05 | $478.63 | $478.63 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $190.55 Typical High $190.55 | Professional | 53 · Discontinued | $158.49 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $707.95 Typical High $707.95 | Professional | 54 · Surgery only | $588.84 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $117.49 Median $141.25 Typical High $141.25 | Professional | 55 · Aftercare only | $117.49 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $95.50 Typical High $95.50 | Professional | 56 · Pre-op care only | $79.43 | $95.50 | $95.50 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,318.26 Median $2,137.96 Typical High $2,630.27 | Professional | 50 · Both sides | $1,318.26 | $2,137.96 | $2,630.27 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $389.05 Median $478.63 Typical High $478.63 | Professional | 52 · Reduced service | $389.05 | $478.63 | $478.63 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $190.55 Typical High $190.55 | Professional | 53 · Discontinued | $158.49 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $707.95 Typical High $707.95 | Professional | 54 · Surgery only | $588.84 | $707.95 | $707.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $117.49 Median $141.25 Typical High $141.25 | Professional | 55 · Aftercare only | $117.49 | $141.25 | $141.25 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $95.50 Typical High $95.50 | Professional | 56 · Pre-op care only | $79.43 | $95.50 | $95.50 |
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· 41st of 51
$955
AK $3,548UT $631
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.