How much rates vary
Facilitymedian $3,631 · 10th to 90th $741 to $7,413Professionalmedian $1,349 · 10th to 90th $1,148 to $2,344
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 $891.25 Median $3,890.45 Typical High $8,317.64 | Facility | None | $891.25 | $3,890.45 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $1,148.15 Median $1,258.93 Typical High $1,348.96 | Professional | None | $1,148.15 | $1,258.93 | $1,348.96 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $870.96 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $794.33 | $870.96 | $933.25 |
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 $1,318.26 Median $1,380.38 Typical High $2,570.40 | Professional | None | $1,318.26 | $1,380.38 | $2,570.40 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,047.13 Typical High $1,949.84 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,047.13 | $1,949.84 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $2,691.53 Typical High $6,760.83 | Facility | None | $501.19 | $2,691.53 | $6,760.83 |
Cigna Setting Professional Modifier None Typical Low $1,202.26 Median $1,318.26 Typical High $2,818.38 | Professional | None | $1,202.26 | $1,318.26 | $2,818.38 |
Emblem Health Setting Professional Modifier None Typical Low $1,513.56 Median $2,089.30 Typical High $2,089.30 | Professional | None | $1,513.56 | $2,089.30 | $2,089.30 |
Geisinger Setting Facility Modifier None Typical Low $4,073.80 Median $5,011.87 Typical High $8,912.51 | Facility | None | $4,073.80 | $5,011.87 | $8,912.51 |
Geisinger Setting Professional Modifier None Typical Low $1,122.02 Median $1,445.44 Typical High $2,570.40 | Professional | None | $1,122.02 | $1,445.44 | $2,570.40 |
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 $1,148.15 Median $1,230.27 Typical High $1,348.96 | Professional | None | $1,148.15 | $1,230.27 | $1,348.96 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $851.14 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $794.33 | $851.14 | $933.25 |
Oscar Health Setting Professional Modifier None Typical Low $1,445.44 Median $1,445.44 Typical High $2,570.40 | Professional | None | $1,445.44 | $1,445.44 | $2,570.40 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,258.93 Median $1,737.80 Typical High $3,388.44 | Facility | None | $1,258.93 | $1,737.80 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,288.25 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,288.25 | $1,445.44 | $1,445.44 |
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 $1,258.93 Median $1,698.24 Typical High $2,187.76 | Professional | None | $1,258.93 | $1,698.24 | $2,187.76 |
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 $575.44 Median $630.96 Typical High $676.08 | Professional | 52 · Reduced service | $575.44 | $630.96 | $676.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $251.19 Typical High $269.15 | Professional | 53 · Discontinued | $229.09 | $251.19 | $269.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $933.25 Typical High $1,000.00 | Professional | 54 · Surgery only | $851.14 | $933.25 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $190.55 Typical High $199.53 | Professional | 55 · Aftercare only | $169.82 | $190.55 | $199.53 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $125.89 Typical High $134.90 | Professional | 56 · Pre-op care only | $114.82 | $125.89 | $134.90 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $575.44 Median $602.56 Typical High $676.08 | Professional | 52 · Reduced service | $575.44 | $602.56 | $676.08 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $245.47 Typical High $269.15 | Professional | 53 · Discontinued | $229.09 | $245.47 | $269.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $912.01 Typical High $1,000.00 | Professional | 54 · Surgery only | $851.14 | $912.01 | $1,000.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $181.97 Typical High $199.53 | Professional | 55 · Aftercare only | $169.82 | $181.97 | $199.53 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $123.03 Typical High $134.90 | Professional | 56 · Pre-op care only | $114.82 | $123.03 | $134.90 |
Where Pennsylvania sits
The same service costs 11.0 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
$1,380
AK $5,370TX $490
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.