How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,754 · 10th to 90th $2,291 to $4,571
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 $2,290.87 Median $2,570.40 Typical High $2,754.23 | Professional | None | $2,290.87 | $2,570.40 | $2,754.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,584.89 Median $1,905.46 Typical High $1,905.46 | Professional | 78 · Unplanned return to OR | $1,584.89 | $1,905.46 | $1,905.46 |
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 $4,265.80 Median $4,265.80 Typical High $56,234.13 | Professional | None | $4,265.80 | $4,265.80 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,041.74 Median $3,235.94 Typical High $4,168.69 | Professional | 78 · Unplanned return to OR | $2,041.74 | $3,235.94 | $4,168.69 |
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 $2,290.87 Median $2,884.03 Typical High $5,370.32 | Professional | None | $2,290.87 | $2,884.03 | $5,370.32 |
Emblem Health Setting Professional Modifier None Typical Low $3,981.07 Median $3,981.07 Typical High $4,677.35 | Professional | None | $3,981.07 | $3,981.07 | $4,677.35 |
Geisinger Setting Professional Modifier None Typical Low $1,905.46 Median $3,235.94 Typical High $5,495.41 | Professional | None | $1,905.46 | $3,235.94 | $5,495.41 |
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 $2,290.87 Median $2,570.40 Typical High $2,754.23 | Professional | None | $2,290.87 | $2,570.40 | $2,754.23 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,584.89 Median $1,905.46 Typical High $1,905.46 | Professional | 78 · Unplanned return to OR | $1,584.89 | $1,905.46 | $1,905.46 |
Oscar Health Setting Professional Modifier None Typical Low $10.96 Median $2,398.83 Typical High $4,897.79 | Professional | None | $10.96 | $2,398.83 | $4,897.79 |
UPMC Health Plan Setting Facility Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $2,630.27 | Facility | None | $2,511.89 | $2,511.89 | $2,630.27 |
UPMC Health Plan Setting Professional Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $2,630.27 | Professional | None | $2,511.89 | $2,511.89 | $2,630.27 |
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 $2,511.89 Median $3,467.37 Typical High $5,495.41 | Professional | None | $2,511.89 | $3,467.37 | $5,495.41 |
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 $1,148.15 Median $1,348.96 Typical High $1,380.38 | Professional | 52 · Reduced service | $1,148.15 | $1,348.96 | $1,380.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $457.09 Median $549.54 Typical High $549.54 | Professional | 53 · Discontinued | $457.09 | $549.54 | $549.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,698.24 Median $2,041.74 Typical High $2,041.74 | Professional | 54 · Surgery only | $1,698.24 | $2,041.74 | $2,041.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $338.84 Median $407.38 Typical High $407.38 | Professional | 55 · Aftercare only | $338.84 | $407.38 | $407.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $229.09 Median $275.42 Typical High $275.42 | Professional | 56 · Pre-op care only | $229.09 | $275.42 | $275.42 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,148.15 Median $1,348.96 Typical High $1,380.38 | Professional | 52 · Reduced service | $1,148.15 | $1,348.96 | $1,380.38 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $457.09 Median $549.54 Typical High $549.54 | Professional | 53 · Discontinued | $457.09 | $549.54 | $549.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,698.24 Median $2,041.74 Typical High $2,041.74 | Professional | 54 · Surgery only | $1,698.24 | $2,041.74 | $2,041.74 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $338.84 Median $407.38 Typical High $407.38 | Professional | 55 · Aftercare only | $338.84 | $407.38 | $407.38 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $229.09 Median $275.42 Typical High $275.42 | Professional | 56 · Pre-op care only | $229.09 | $275.42 | $275.42 |
Where Pennsylvania sits
The same service costs 17.0 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
$2,630
AK $10,965TX $646
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.