How much rates vary
Facilitymedian $1,479 · 10th to 90th $692 to $5,012Professionalmedian $1,202 · 10th to 90th $1,023 to $2,089
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 $954.99 Median $3,090.30 Typical High $8,511.38 | Facility | None | $954.99 | $3,090.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,000.00 Median $1,096.48 Typical High $1,202.26 | Professional | None | $1,000.00 | $1,096.48 | $1,202.26 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $707.95 Median $758.58 Typical High $831.76 | Professional | 78 · Unplanned return to OR | $707.95 | $758.58 | $831.76 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $56,234.13 | Facility | None | $3,981.07 | $7,413.10 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,174.90 Median $1,230.27 Typical High $2,238.72 | Professional | None | $1,174.90 | $1,230.27 | $2,238.72 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $891.25 Median $933.25 Typical High $1,698.24 | Professional | 78 · Unplanned return to OR | $891.25 | $933.25 | $1,698.24 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $912.01 Typical High $1,819.70 | Facility | None | $478.63 | $912.01 | $1,819.70 |
Cigna Setting Professional Modifier None Typical Low $1,122.02 Median $1,174.90 Typical High $2,454.71 | Professional | None | $1,122.02 | $1,174.90 | $2,454.71 |
Emblem Health Setting Professional Modifier None Typical Low $1,348.96 Median $1,862.09 Typical High $1,862.09 | Professional | None | $1,348.96 | $1,862.09 | $1,862.09 |
Geisinger Setting Facility Modifier None Typical Low $912.01 Median $1,148.15 Typical High $2,041.74 | Facility | None | $912.01 | $1,148.15 | $2,041.74 |
Geisinger Setting Professional Modifier None Typical Low $1,071.52 Median $1,412.54 Typical High $2,570.40 | Professional | None | $1,071.52 | $1,412.54 | $2,570.40 |
Martin's Point Setting Facility Modifier None Typical Low $954.99 Median $2,754.23 Typical High $8,317.64 | Facility | None | $954.99 | $2,754.23 | $8,317.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,000.00 Median $1,071.52 Typical High $1,202.26 | Professional | None | $1,000.00 | $1,071.52 | $1,202.26 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $707.95 Median $758.58 Typical High $831.76 | Professional | 78 · Unplanned return to OR | $707.95 | $758.58 | $831.76 |
Oscar Health Setting Professional Modifier None Typical Low $1,318.26 Median $1,318.26 Typical High $2,454.71 | Professional | None | $1,318.26 | $1,318.26 | $2,454.71 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,096.48 Median $1,513.56 Typical High $3,019.95 | Facility | None | $1,096.48 | $1,513.56 | $3,019.95 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,148.15 Median $1,202.26 Typical High $1,202.26 | Professional | None | $1,148.15 | $1,202.26 | $1,202.26 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,905.46 Typical High $4,365.16 | Facility | None | $1,148.15 | $1,905.46 | $4,365.16 |
United Setting Professional Modifier None Typical Low $1,122.02 Median $1,548.82 Typical High $1,949.84 | Professional | None | $1,122.02 | $1,548.82 | $1,949.84 |
11 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 $501.19 Median $549.54 Typical High $602.56 | Professional | 52 · Reduced service | $501.19 | $549.54 | $602.56 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $204.17 Median $218.78 Typical High $239.88 | Professional | 53 · Discontinued | $204.17 | $218.78 | $239.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $758.58 Median $812.83 Typical High $891.25 | Professional | 54 · Surgery only | $758.58 | $812.83 | $891.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $162.18 Typical High $177.83 | Professional | 55 · Aftercare only | $151.36 | $162.18 | $177.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $109.65 Typical High $120.23 | Professional | 56 · Pre-op care only | $100.00 | $109.65 | $120.23 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,778.28 Median $1,819.70 Typical High $3,388.44 | Professional | 50 · Both sides | $1,778.28 | $1,819.70 | $3,388.44 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $501.19 Median $537.03 Typical High $602.56 | Professional | 52 · Reduced service | $501.19 | $537.03 | $602.56 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $204.17 Median $213.80 Typical High $239.88 | Professional | 53 · Discontinued | $204.17 | $213.80 | $239.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $758.58 Median $812.83 Typical High $891.25 | Professional | 54 · Surgery only | $758.58 | $812.83 | $891.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $162.18 Typical High $177.83 | Professional | 55 · Aftercare only | $151.36 | $162.18 | $177.83 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $107.15 Typical High $120.23 | Professional | 56 · Pre-op care only | $100.00 | $107.15 | $120.23 |
Where Pennsylvania sits
The same service costs 6.2 times more in Alaska than in Utah. 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
$1,202
AK $4,786UT $776
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.