How much rates vary
Facilitymedian $2,138 · 10th to 90th $776 to $6,457Professionalmedian $708 · 10th to 90th $617 to $1,349
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 $812.83 Median $4,897.79 Typical High $8,511.38 | Facility | None | $812.83 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $616.60 Median $645.65 Typical High $758.58 | Professional | None | $616.60 | $645.65 | $758.58 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $426.58 Median $446.68 Typical High $501.19 | Professional | 78 · Unplanned return to OR | $426.58 | $446.68 | $501.19 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $56,234.13 | Facility | None | $3,981.07 | $7,413.10 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,174.90 Median $1,348.96 Typical High $1,348.96 | Professional | None | $1,174.90 | $1,348.96 | $1,348.96 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $891.25 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $562.34 | $891.25 | $1,122.02 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,659.59 Typical High $2,818.38 | Facility | None | $616.60 | $1,659.59 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $660.69 Median $741.31 Typical High $1,348.96 | Professional | None | $660.69 | $741.31 | $1,348.96 |
Emblem Health Setting Professional Modifier None Typical Low $1,000.00 Median $1,000.00 Typical High $1,071.52 | Professional | None | $1,000.00 | $1,000.00 | $1,071.52 |
Geisinger Setting Facility Modifier None Typical Low $1,659.59 Median $2,089.30 Typical High $3,630.78 | Facility | None | $1,659.59 | $2,089.30 | $3,630.78 |
Geisinger Setting Professional Modifier None Typical Low $645.65 Median $870.96 Typical High $1,380.38 | Professional | None | $645.65 | $870.96 | $1,380.38 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $4,570.88 Typical High $8,511.38 | Facility | None | $831.76 | $4,570.88 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $616.60 Median $645.65 Typical High $724.44 | Professional | None | $616.60 | $645.65 | $724.44 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $426.58 Median $446.68 Typical High $478.63 | Professional | 78 · Unplanned return to OR | $426.58 | $446.68 | $478.63 |
Oscar Health Setting Professional Modifier None Typical Low $794.33 Median $933.25 Typical High $1,548.82 | Professional | None | $794.33 | $933.25 | $1,548.82 |
UPMC Health Plan Setting Facility Modifier None Typical Low $676.08 Median $2,137.96 Typical High $4,265.80 | Facility | None | $676.08 | $2,137.96 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $676.08 Median $776.25 Typical High $776.25 | Professional | None | $676.08 | $776.25 | $776.25 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,905.46 Typical High $6,025.60 | Facility | None | $1,148.15 | $1,905.46 | $6,025.60 |
United Setting Professional Modifier None Typical Low $660.69 Median $831.76 Typical High $1,412.54 | Professional | None | $660.69 | $831.76 | $1,412.54 |
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 $309.03 Median $323.59 Typical High $363.08 | Professional | 52 · Reduced service | $309.03 | $323.59 | $363.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $123.03 Median $128.82 Typical High $144.54 | Professional | 53 · Discontinued | $123.03 | $128.82 | $144.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $457.09 Median $478.63 Typical High $537.03 | Professional | 54 · Surgery only | $457.09 | $478.63 | $537.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $93.33 Median $95.50 Typical High $107.15 | Professional | 55 · Aftercare only | $93.33 | $95.50 | $107.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $61.66 Median $64.57 Typical High $72.44 | Professional | 56 · Pre-op care only | $61.66 | $64.57 | $72.44 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $309.03 Median $323.59 Typical High $338.84 | Professional | 52 · Reduced service | $309.03 | $323.59 | $338.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $123.03 Median $128.82 Typical High $138.04 | Professional | 53 · Discontinued | $123.03 | $128.82 | $138.04 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $457.09 Median $478.63 Typical High $512.86 | Professional | 54 · Surgery only | $457.09 | $478.63 | $512.86 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $93.33 Median $95.50 Typical High $102.33 | Professional | 55 · Aftercare only | $93.33 | $95.50 | $102.33 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $61.66 Median $64.57 Typical High $67.61 | Professional | 56 · Pre-op care only | $61.66 | $64.57 | $67.61 |
Where Pennsylvania sits
The same service costs 5.8 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· 46th of 51
$813
AK $2,818UT $490
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.