How much rates vary
Facilitymedian $170 · 10th to 90th $65 to $3,981Professionalmedian $126 · 10th to 90th $93 to $209
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 $125.89 Median $3,630.78 Typical High $8,511.38 | Facility | None | $125.89 | $3,630.78 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $93.33 Median $125.89 Typical High $169.82 | Professional | None | $93.33 | $125.89 | $169.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $64.57 Median $89.13 Typical High $91.20 | Professional | 78 · Unplanned return to OR | $64.57 | $89.13 | $91.20 |
Capital Blue Cross Setting Facility Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $8,709.64 | Facility | None | $1,202.26 | $1,412.54 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $56,234.13 | Professional | None | $165.96 | $165.96 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $169.82 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $114.82 | $169.82 | $204.17 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $120.23 | Facility | None | $50.12 | $66.07 | $120.23 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $134.90 Typical High $234.42 | Professional | None | $93.33 | $134.90 | $234.42 |
Emblem Health Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $245.47 | Professional | None | $239.88 | $239.88 | $245.47 |
Geisinger Setting Professional Modifier None Typical Low $95.50 Median $154.88 Typical High $239.88 | Professional | None | $95.50 | $154.88 | $239.88 |
Martin's Point Setting Facility Modifier None Typical Low $125.89 Median $3,630.78 Typical High $8,709.64 | Facility | None | $125.89 | $3,630.78 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $93.33 Median $125.89 Typical High $162.18 | Professional | None | $93.33 | $125.89 | $162.18 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $64.57 Median $89.13 Typical High $91.20 | Professional | 78 · Unplanned return to OR | $64.57 | $89.13 | $91.20 |
Oscar Health Setting Professional Modifier None Typical Low $151.36 Median $162.18 Typical High $269.15 | Professional | None | $151.36 | $162.18 | $269.15 |
UPMC Health Plan Setting Facility Modifier None Typical Low $85.11 Median $147.91 Typical High $316.23 | Facility | None | $85.11 | $147.91 | $316.23 |
UPMC Health Plan Setting Professional Modifier None Typical Low $85.11 Median $138.04 Typical High $147.91 | Professional | None | $85.11 | $138.04 | $147.91 |
United Setting Facility Modifier None Typical Low $77.62 Median $158.49 Typical High $1,348.96 | Facility | None | $77.62 | $158.49 | $1,348.96 |
United Setting Professional Modifier None Typical Low $102.33 Median $134.90 Typical High $229.09 | Professional | None | $102.33 | $134.90 | $229.09 |
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 $46.77 Median $63.10 Typical High $64.57 | Professional | 52 · Reduced service | $46.77 | $63.10 | $64.57 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.62 Median $25.12 Typical High $25.70 | Professional | 53 · Discontinued | $18.62 | $25.12 | $25.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $95.50 Typical High $97.72 | Professional | 54 · Surgery only | $69.18 | $95.50 | $97.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.80 Median $19.05 Typical High $19.50 | Professional | 55 · Aftercare only | $13.80 | $19.05 | $19.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.33 Median $12.59 Typical High $12.88 | Professional | 56 · Pre-op care only | $9.33 | $12.59 | $12.88 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $46.77 Median $63.10 Typical High $64.57 | Professional | 52 · Reduced service | $46.77 | $63.10 | $64.57 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $18.62 Median $25.12 Typical High $25.70 | Professional | 53 · Discontinued | $18.62 | $25.12 | $25.70 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $95.50 Typical High $97.72 | Professional | 54 · Surgery only | $69.18 | $95.50 | $97.72 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $13.80 Median $19.05 Typical High $19.50 | Professional | 55 · Aftercare only | $13.80 | $19.05 | $19.50 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $9.33 Median $12.59 Typical High $12.88 | Professional | 56 · Pre-op care only | $9.33 | $12.59 | $12.88 |
Where Pennsylvania sits
The same service costs 4.2 times more in Alaska than in Kentucky. 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· 49th of 51
$129
AK $437KY $105
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.