How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,399 · 10th to 90th $1,995 to $3,981
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 $1,995.26 Median $2,290.87 Typical High $2,398.83 | Professional | None | $1,995.26 | $2,290.87 | $2,398.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,380.38 Median $1,659.59 Typical High $1,659.59 | Professional | 78 · Unplanned return to OR | $1,380.38 | $1,659.59 | $1,659.59 |
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 $3,630.78 Median $3,630.78 Typical High $56,234.13 | Professional | None | $3,630.78 | $3,630.78 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,778.28 Median $2,818.38 Typical High $3,548.13 | Professional | 78 · Unplanned return to OR | $1,778.28 | $2,818.38 | $3,548.13 |
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 $2,137.96 Median $2,511.89 Typical High $4,677.35 | Professional | None | $2,137.96 | $2,511.89 | $4,677.35 |
Emblem Health Setting Professional Modifier None Typical Low $3,548.13 Median $3,548.13 Typical High $4,073.80 | Professional | None | $3,548.13 | $3,548.13 | $4,073.80 |
Geisinger Setting Professional Modifier None Typical Low $2,137.96 Median $2,818.38 Typical High $4,786.30 | Professional | None | $2,137.96 | $2,818.38 | $4,786.30 |
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 $1,995.26 Median $2,344.23 Typical High $2,398.83 | Professional | None | $1,995.26 | $2,344.23 | $2,398.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,380.38 Median $1,659.59 Typical High $1,659.59 | Professional | 78 · Unplanned return to OR | $1,380.38 | $1,659.59 | $1,659.59 |
Oscar Health Setting Professional Modifier None Typical Low $10.96 Median $2,570.40 Typical High $4,466.84 | Professional | None | $10.96 | $2,570.40 | $4,466.84 |
UPMC Health Plan Setting Facility Modifier None Typical Low $2,290.87 Median $2,454.71 Typical High $2,454.71 | Facility | None | $2,290.87 | $2,454.71 | $2,454.71 |
UPMC Health Plan Setting Professional Modifier None Typical Low $2,290.87 Median $2,454.71 Typical High $2,454.71 | Professional | None | $2,290.87 | $2,454.71 | $2,454.71 |
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 $2,344.23 Median $3,019.95 Typical High $4,677.35 | Professional | None | $2,344.23 | $3,019.95 | $4,677.35 |
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 $1,000.00 Median $1,174.90 Typical High $1,174.90 | Professional | 52 · Reduced service | $1,000.00 | $1,174.90 | $1,174.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $398.11 Median $467.74 Typical High $478.63 | Professional | 53 · Discontinued | $398.11 | $467.74 | $478.63 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,479.11 Median $1,778.28 Typical High $1,778.28 | Professional | 54 · Surgery only | $1,479.11 | $1,778.28 | $1,778.28 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $295.12 Median $354.81 Typical High $354.81 | Professional | 55 · Aftercare only | $295.12 | $354.81 | $354.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $199.53 Median $234.42 Typical High $239.88 | Professional | 56 · Pre-op care only | $199.53 | $234.42 | $239.88 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,000.00 Median $1,174.90 Typical High $1,174.90 | Professional | 52 · Reduced service | $1,000.00 | $1,174.90 | $1,174.90 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $398.11 Median $467.74 Typical High $478.63 | Professional | 53 · Discontinued | $398.11 | $467.74 | $478.63 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,479.11 Median $1,778.28 Typical High $1,778.28 | Professional | 54 · Surgery only | $1,479.11 | $1,778.28 | $1,778.28 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $295.12 Median $354.81 Typical High $354.81 | Professional | 55 · Aftercare only | $295.12 | $354.81 | $354.81 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $199.53 Median $234.42 Typical High $239.88 | Professional | 56 · Pre-op care only | $199.53 | $234.42 | $239.88 |
Where Pennsylvania sits
The same service costs 7.6 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· 40th of 51
$2,399
AK $9,550TX $1,259
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.