How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,023 · 10th to 90th $851 to $1,698
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 $851.14 Median $1,000.00 Typical High $1,023.29 | Professional | None | $851.14 | $1,000.00 | $1,023.29 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $707.95 Typical High $707.95 | Professional | 78 · Unplanned return to OR | $588.84 | $707.95 | $707.95 |
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 $1,584.89 Median $1,584.89 Typical High $56,234.13 | Professional | None | $1,584.89 | $1,584.89 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $1,202.26 Typical High $1,513.56 | Professional | 78 · Unplanned return to OR | $758.58 | $1,202.26 | $1,513.56 |
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 $912.01 Median $1,047.13 Typical High $1,995.26 | Professional | None | $912.01 | $1,047.13 | $1,995.26 |
Emblem Health Setting Professional Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $1,819.70 | Professional | None | $1,584.89 | $1,584.89 | $1,819.70 |
Geisinger Setting Professional Modifier None Typical Low $851.14 Median $1,230.27 Typical High $2,089.30 | Professional | None | $851.14 | $1,230.27 | $2,089.30 |
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 $851.14 Median $1,000.00 Typical High $1,023.29 | Professional | None | $851.14 | $1,000.00 | $1,023.29 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $707.95 Typical High $707.95 | Professional | 78 · Unplanned return to OR | $588.84 | $707.95 | $707.95 |
Oscar Health Setting Professional Modifier None Typical Low $1,047.13 Median $1,122.02 Typical High $1,905.46 | Professional | None | $1,047.13 | $1,122.02 | $1,905.46 |
UPMC Health Plan Setting Facility Modifier None Typical Low $977.24 Median $1,258.93 Typical High $1,258.93 | Facility | None | $977.24 | $1,258.93 | $1,258.93 |
UPMC Health Plan Setting Professional Modifier None Typical Low $977.24 Median $1,258.93 Typical High $1,258.93 | Professional | None | $977.24 | $1,258.93 | $1,258.93 |
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 $977.24 Median $1,288.25 Typical High $1,995.26 | Professional | None | $977.24 | $1,288.25 | $1,995.26 |
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 $426.58 Median $501.19 Typical High $512.86 | Professional | 52 · Reduced service | $426.58 | $501.19 | $512.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $199.53 Typical High $204.17 | Professional | 53 · Discontinued | $169.82 | $199.53 | $204.17 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $758.58 Typical High $758.58 | Professional | 54 · Surgery only | $630.96 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $151.36 Typical High $151.36 | Professional | 55 · Aftercare only | $125.89 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $100.00 Typical High $102.33 | Professional | 56 · Pre-op care only | $85.11 | $100.00 | $102.33 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $426.58 Median $501.19 Typical High $512.86 | Professional | 52 · Reduced service | $426.58 | $501.19 | $512.86 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $199.53 Typical High $204.17 | Professional | 53 · Discontinued | $169.82 | $199.53 | $204.17 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $758.58 Typical High $758.58 | Professional | 54 · Surgery only | $630.96 | $758.58 | $758.58 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $151.36 Typical High $151.36 | Professional | 55 · Aftercare only | $125.89 | $151.36 | $151.36 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $100.00 Typical High $102.33 | Professional | 56 · Pre-op care only | $85.11 | $100.00 | $102.33 |
Where Pennsylvania sits
The same service costs 6.8 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
$1,023
AK $4,074TX $603
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.