How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,202 · 10th to 90th $1,072 to $2,138
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 $1,071.52 Median $1,174.90 Typical High $1,258.93 | Professional | None | $1,071.52 | $1,174.90 | $1,258.93 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $831.76 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $758.58 | $831.76 | $891.25 |
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 $2,187.76 Median $2,187.76 Typical High $2,290.87 | Professional | None | $2,187.76 | $2,187.76 | $2,290.87 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $977.24 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $933.25 | $977.24 | $1,737.80 |
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 $1,122.02 Median $1,202.26 Typical High $2,570.40 | Professional | None | $1,122.02 | $1,202.26 | $2,570.40 |
Emblem Health Setting Professional Modifier None Typical Low $1,445.44 Median $1,949.84 Typical High $1,949.84 | Professional | None | $1,445.44 | $1,949.84 | $1,949.84 |
Geisinger Setting Professional Modifier None Typical Low $1,071.52 Median $1,445.44 Typical High $2,570.40 | Professional | None | $1,071.52 | $1,445.44 | $2,570.40 |
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 $1,071.52 Median $1,148.15 Typical High $1,258.93 | Professional | None | $1,071.52 | $1,148.15 | $1,258.93 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $794.33 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $758.58 | $794.33 | $891.25 |
Oscar Health Setting Professional Modifier None Typical Low $1,202.26 Median $1,202.26 Typical High $2,398.83 | Professional | None | $1,202.26 | $1,202.26 | $2,398.83 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,202.26 | Facility | None | $1,174.90 | $1,174.90 | $1,202.26 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,174.90 Median $1,174.90 Typical High $1,202.26 | Professional | None | $1,174.90 | $1,174.90 | $1,202.26 |
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 $1,174.90 Median $1,621.81 Typical High $2,089.30 | Professional | None | $1,174.90 | $1,621.81 | $2,089.30 |
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 $537.03 Median $588.84 Typical High $630.96 | Professional | 52 · Reduced service | $537.03 | $588.84 | $630.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $213.80 Median $234.42 Typical High $251.19 | Professional | 53 · Discontinued | $213.80 | $234.42 | $251.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $891.25 Typical High $954.99 | Professional | 54 · Surgery only | $812.83 | $891.25 | $954.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $162.18 Median $177.83 Typical High $190.55 | Professional | 55 · Aftercare only | $162.18 | $177.83 | $190.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $107.15 Median $117.49 Typical High $125.89 | Professional | 56 · Pre-op care only | $107.15 | $117.49 | $125.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $537.03 Median $575.44 Typical High $630.96 | Professional | 52 · Reduced service | $537.03 | $575.44 | $630.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $213.80 Median $229.09 Typical High $251.19 | Professional | 53 · Discontinued | $213.80 | $229.09 | $251.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $851.14 Typical High $954.99 | Professional | 54 · Surgery only | $812.83 | $851.14 | $954.99 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $162.18 Median $173.78 Typical High $190.55 | Professional | 55 · Aftercare only | $162.18 | $173.78 | $190.55 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $107.15 Median $114.82 Typical High $125.89 | Professional | 56 · Pre-op care only | $107.15 | $114.82 | $125.89 |
Where Pennsylvania sits
The same service costs 6.5 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· 44th of 51
$1,202
AK $5,012TX $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.