How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,188 · 10th to 90th $1,820 to $3,548
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 $1,819.70 Median $2,041.74 Typical High $2,187.76 | Professional | None | $1,819.70 | $2,041.74 | $2,187.76 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,288.25 Median $1,412.54 Typical High $1,548.82 | Professional | 78 · Unplanned return to OR | $1,288.25 | $1,412.54 | $1,548.82 |
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 $2,137.96 Median $2,137.96 Typical High $2,238.72 | Professional | None | $2,137.96 | $2,137.96 | $2,238.72 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,659.59 Median $2,630.27 Typical High $3,311.31 | Professional | 78 · Unplanned return to OR | $1,659.59 | $2,630.27 | $3,311.31 |
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 $1,778.28 Median $2,344.23 Typical High $4,168.69 | Professional | None | $1,778.28 | $2,344.23 | $4,168.69 |
Emblem Health Setting Professional Modifier None Typical Low $3,311.31 Median $3,311.31 Typical High $3,801.89 | Professional | None | $3,311.31 | $3,311.31 | $3,801.89 |
Geisinger Setting Professional Modifier None Typical Low $1,778.28 Median $2,630.27 Typical High $3,981.07 | Professional | None | $1,778.28 | $2,630.27 | $3,981.07 |
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 $1,819.70 Median $2,041.74 Typical High $2,187.76 | Professional | None | $1,819.70 | $2,041.74 | $2,187.76 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,288.25 Median $1,412.54 Typical High $1,548.82 | Professional | 78 · Unplanned return to OR | $1,288.25 | $1,412.54 | $1,548.82 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $2,187.76 Typical High $3,890.45 | Professional | None | $15.14 | $2,187.76 | $3,890.45 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,862.09 Median $1,862.09 Typical High $2,089.30 | Facility | None | $1,862.09 | $1,862.09 | $2,089.30 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,862.09 Median $1,862.09 Typical High $2,089.30 | Professional | None | $1,862.09 | $1,862.09 | $2,089.30 |
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 $2,089.30 Median $2,754.23 Typical High $4,365.16 | Professional | None | $2,089.30 | $2,754.23 | $4,365.16 |
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 $912.01 Median $1,023.29 Typical High $1,096.48 | Professional | 52 · Reduced service | $912.01 | $1,023.29 | $1,096.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $371.54 Median $407.38 Typical High $436.52 | Professional | 53 · Discontinued | $371.54 | $407.38 | $436.52 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,380.38 Median $1,513.56 Typical High $1,659.59 | Professional | 54 · Surgery only | $1,380.38 | $1,513.56 | $1,659.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $275.42 Median $302.00 Typical High $331.13 | Professional | 55 · Aftercare only | $275.42 | $302.00 | $331.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $186.21 Median $204.17 Typical High $218.78 | Professional | 56 · Pre-op care only | $186.21 | $204.17 | $218.78 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $912.01 Median $1,023.29 Typical High $1,096.48 | Professional | 52 · Reduced service | $912.01 | $1,023.29 | $1,096.48 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $371.54 Median $407.38 Typical High $436.52 | Professional | 53 · Discontinued | $371.54 | $407.38 | $436.52 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,380.38 Median $1,513.56 Typical High $1,659.59 | Professional | 54 · Surgery only | $1,380.38 | $1,513.56 | $1,659.59 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $275.42 Median $302.00 Typical High $331.13 | Professional | 55 · Aftercare only | $275.42 | $302.00 | $331.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $186.21 Median $204.17 Typical High $218.78 | Professional | 56 · Pre-op care only | $186.21 | $204.17 | $218.78 |
Where Pennsylvania sits
The same service costs 8.1 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
$2,138
AK $8,913TX $1,096
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.