How much rates vary
Facilitymedian $3,090 · 10th to 90th $692 to $10,000Professionalmedian $1,072 · 10th to 90th $912 to $1,862
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 $912.01 Median $1,000.00 Typical High $1,071.52 | Professional | None | $912.01 | $1,000.00 | $1,071.52 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $691.83 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $630.96 | $691.83 | $741.31 |
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 $1,047.13 Median $1,096.48 Typical High $1,995.26 | Professional | None | $1,047.13 | $1,096.48 | $1,995.26 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $831.76 Typical High $1,513.56 | Professional | 78 · Unplanned return to OR | $794.33 | $831.76 | $1,513.56 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $2,187.76 Typical High $10,715.19 | Facility | None | $478.63 | $2,187.76 | $10,715.19 |
Cigna Setting Professional Modifier None Typical Low $977.24 Median $1,071.52 Typical High $2,238.72 | Professional | None | $977.24 | $1,071.52 | $2,238.72 |
Emblem Health Setting Professional Modifier None Typical Low $1,230.27 Median $1,659.59 Typical High $1,659.59 | Professional | None | $1,230.27 | $1,659.59 | $1,659.59 |
Geisinger Setting Facility Modifier None Typical Low $6,456.54 Median $7,943.28 Typical High $14,125.38 | Facility | None | $6,456.54 | $7,943.28 | $14,125.38 |
Geisinger Setting Professional Modifier None Typical Low $933.25 Median $1,230.27 Typical High $2,187.76 | Professional | None | $933.25 | $1,230.27 | $2,187.76 |
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 $912.01 Median $1,000.00 Typical High $1,071.52 | Professional | None | $912.01 | $1,000.00 | $1,071.52 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $676.08 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $630.96 | $676.08 | $741.31 |
Oscar Health Setting Professional Modifier None Typical Low $1,122.02 Median $1,122.02 Typical High $2,089.30 | Professional | None | $1,122.02 | $1,122.02 | $2,089.30 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,023.29 Median $1,513.56 Typical High $3,019.95 | Facility | None | $1,023.29 | $1,513.56 | $3,019.95 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,023.29 Median $1,071.52 Typical High $1,071.52 | Professional | None | $1,023.29 | $1,071.52 | $1,071.52 |
United Setting Facility Modifier None Typical Low $1,380.38 Median $2,398.83 Typical High $6,918.31 | Facility | None | $1,380.38 | $2,398.83 | $6,918.31 |
United Setting Professional Modifier None Typical Low $1,000.00 Median $1,380.38 Typical High $1,737.80 | Professional | None | $1,000.00 | $1,380.38 | $1,737.80 |
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 $446.68 Median $501.19 Typical High $537.03 | Professional | 52 · Reduced service | $446.68 | $501.19 | $537.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $181.97 Median $199.53 Typical High $213.80 | Professional | 53 · Discontinued | $181.97 | $199.53 | $213.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $676.08 Median $741.31 Typical High $794.33 | Professional | 54 · Surgery only | $676.08 | $741.31 | $794.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $134.90 Median $147.91 Typical High $158.49 | Professional | 55 · Aftercare only | $134.90 | $147.91 | $158.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $91.20 Median $100.00 Typical High $107.15 | Professional | 56 · Pre-op care only | $91.20 | $100.00 | $107.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $446.68 Median $478.63 Typical High $537.03 | Professional | 52 · Reduced service | $446.68 | $478.63 | $537.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $181.97 Median $194.98 Typical High $213.80 | Professional | 53 · Discontinued | $181.97 | $194.98 | $213.80 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $676.08 Median $724.44 Typical High $794.33 | Professional | 54 · Surgery only | $676.08 | $724.44 | $794.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $134.90 Median $144.54 Typical High $158.49 | Professional | 55 · Aftercare only | $134.90 | $144.54 | $158.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $91.20 Median $95.50 Typical High $107.15 | Professional | 56 · Pre-op care only | $91.20 | $95.50 | $107.15 |
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· 41st of 51
$1,096
AK $4,266UT $692
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.