How much rates vary
Facilitymedian $724 · 10th to 90th $324 to $4,266Professionalmedian $933 · 10th to 90th $759 to $1,445
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 $870.96 Median $3,890.45 Typical High $8,317.64 | Facility | None | $870.96 | $3,890.45 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $812.83 Median $870.96 Typical High $977.24 | Professional | None | $812.83 | $870.96 | $977.24 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $575.44 Median $616.60 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $575.44 | $616.60 | $691.83 |
Capital Blue Cross Setting Facility Modifier None Typical Low $2,630.27 Median $3,019.95 Typical High $56,234.13 | Facility | None | $2,630.27 | $3,019.95 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,412.54 Median $1,513.56 Typical High $56,234.13 | Professional | None | $1,412.54 | $1,513.56 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $758.58 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $741.31 | $758.58 | $1,288.25 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $660.69 Typical High $1,174.90 | Facility | None | $489.78 | $660.69 | $1,174.90 |
Cigna Setting Professional Modifier None Typical Low $707.95 Median $891.25 Typical High $1,995.26 | Professional | None | $707.95 | $891.25 | $1,995.26 |
Emblem Health Setting Professional Modifier None Typical Low $1,202.26 Median $1,737.80 Typical High $1,737.80 | Professional | None | $1,202.26 | $1,737.80 | $1,737.80 |
Geisinger Setting Facility Modifier None Typical Low $467.74 Median $588.84 Typical High $1,023.29 | Facility | None | $467.74 | $588.84 | $1,023.29 |
Geisinger Setting Professional Modifier None Typical Low $724.44 Median $1,148.15 Typical High $1,659.59 | Professional | None | $724.44 | $1,148.15 | $1,659.59 |
Martin's Point Setting Facility Modifier None Typical Low $954.99 Median $3,801.89 Typical High $8,317.64 | Facility | None | $954.99 | $3,801.89 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $812.83 Median $870.96 Typical High $977.24 | Professional | None | $812.83 | $870.96 | $977.24 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $575.44 Median $616.60 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $575.44 | $616.60 | $691.83 |
Oscar Health Setting Professional Modifier None Typical Low $831.76 Median $831.76 Typical High $1,584.89 | Professional | None | $831.76 | $831.76 | $1,584.89 |
UPMC Health Plan Setting Facility Modifier None Typical Low $758.58 Median $1,737.80 Typical High $3,388.44 | Facility | None | $758.58 | $1,737.80 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $758.58 Median $758.58 Typical High $933.25 | Professional | None | $758.58 | $758.58 | $933.25 |
United Setting Facility Modifier None Typical Low $199.53 Median $436.52 Typical High $2,238.72 | Facility | None | $199.53 | $436.52 | $2,238.72 |
United Setting Professional Modifier None Typical Low $831.76 Median $1,202.26 Typical High $1,548.82 | Professional | None | $831.76 | $1,202.26 | $1,548.82 |
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 $407.38 Median $436.52 Typical High $489.78 | Professional | 52 · Reduced service | $407.38 | $436.52 | $489.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $162.18 Median $173.78 Typical High $194.98 | Professional | 53 · Discontinued | $162.18 | $173.78 | $194.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $616.60 Median $660.69 Typical High $741.31 | Professional | 54 · Surgery only | $616.60 | $660.69 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $123.03 Median $131.83 Typical High $147.91 | Professional | 55 · Aftercare only | $123.03 | $131.83 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $87.10 Typical High $97.72 | Professional | 56 · Pre-op care only | $81.28 | $87.10 | $97.72 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $407.38 Median $436.52 Typical High $489.78 | Professional | 52 · Reduced service | $407.38 | $436.52 | $489.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $162.18 Median $173.78 Typical High $194.98 | Professional | 53 · Discontinued | $162.18 | $173.78 | $194.98 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $616.60 Median $660.69 Typical High $741.31 | Professional | 54 · Surgery only | $616.60 | $660.69 | $741.31 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $123.03 Median $131.83 Typical High $147.91 | Professional | 55 · Aftercare only | $123.03 | $131.83 | $147.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $87.10 Typical High $97.72 | Professional | 56 · Pre-op care only | $81.28 | $87.10 | $97.72 |
Where Pennsylvania sits
The same service costs 22.4 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· 39th of 51
$933
AK $3,981TX $178
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.