How much rates vary
Facilitymedian $1,479 · 10th to 90th $692 to $5,370Professionalmedian $955 · 10th to 90th $794 to $1,175
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 $954.99 Median $954.99 Typical High $1,071.52 | Professional | None | $954.99 | $954.99 | $1,071.52 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $676.08 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $660.69 | $676.08 | $741.31 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $6,025.60 Typical High $56,234.13 | Facility | None | $3,981.07 | $6,025.60 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $954.99 Median $1,000.00 Typical High $1,479.11 | Professional | None | $954.99 | $1,000.00 | $1,479.11 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $691.83 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $660.69 | $691.83 | $954.99 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,096.48 Typical High $2,089.30 | Facility | None | $501.19 | $1,096.48 | $2,089.30 |
Cigna Setting Professional Modifier None Typical Low $741.31 Median $851.14 Typical High $1,258.93 | Professional | None | $741.31 | $851.14 | $1,258.93 |
Emblem Health Setting Professional Modifier None Typical Low $1,023.29 Median $1,023.29 Typical High $1,412.54 | Professional | None | $1,023.29 | $1,023.29 | $1,412.54 |
Geisinger Setting Facility Modifier None Typical Low $1,047.13 Median $1,318.26 Typical High $2,290.87 | Facility | None | $1,047.13 | $1,318.26 | $2,290.87 |
Geisinger Setting Professional Modifier None Typical Low $794.33 Median $912.01 Typical High $1,548.82 | Professional | None | $794.33 | $912.01 | $1,548.82 |
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 $954.99 Median $954.99 Typical High $1,071.52 | Professional | None | $954.99 | $954.99 | $1,071.52 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $676.08 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $660.69 | $676.08 | $741.31 |
Oscar Health Setting Professional Modifier None Typical Low $870.96 Median $870.96 Typical High $1,000.00 | Professional | None | $870.96 | $870.96 | $1,000.00 |
UPMC Health Plan Setting Facility Modifier None Typical Low $794.33 Median $1,737.80 Typical High $3,388.44 | Facility | None | $794.33 | $1,737.80 | $3,388.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $794.33 Median $794.33 Typical High $954.99 | Professional | None | $794.33 | $794.33 | $954.99 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,265.80 | Facility | None | $812.83 | $1,318.26 | $4,265.80 |
United Setting Professional Modifier None Typical Low $776.25 Median $1,023.29 Typical High $1,513.56 | Professional | None | $776.25 | $1,023.29 | $1,513.56 |
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 $478.63 Median $478.63 Typical High $537.03 | Professional | 52 · Reduced service | $478.63 | $478.63 | $537.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $190.55 Median $190.55 Typical High $213.80 | Professional | 53 · Discontinued | $190.55 | $190.55 | $213.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $707.95 Median $724.44 Typical High $794.33 | Professional | 54 · Surgery only | $707.95 | $724.44 | $794.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $141.25 Median $144.54 Typical High $158.49 | Professional | 55 · Aftercare only | $141.25 | $144.54 | $158.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $95.50 Median $95.50 Typical High $107.15 | Professional | 56 · Pre-op care only | $95.50 | $95.50 | $107.15 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,445.44 Median $1,479.11 Typical High $2,041.74 | Professional | 50 · Both sides | $1,445.44 | $1,479.11 | $2,041.74 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $478.63 Median $478.63 Typical High $537.03 | Professional | 52 · Reduced service | $478.63 | $478.63 | $537.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $190.55 Median $190.55 Typical High $213.80 | Professional | 53 · Discontinued | $190.55 | $190.55 | $213.80 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $707.95 Median $724.44 Typical High $794.33 | Professional | 54 · Surgery only | $707.95 | $724.44 | $794.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $141.25 Median $144.54 Typical High $158.49 | Professional | 55 · Aftercare only | $141.25 | $144.54 | $158.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $95.50 Median $95.50 Typical High $107.15 | Professional | 56 · Pre-op care only | $95.50 | $95.50 | $107.15 |
Where Pennsylvania sits
The same service costs 7.4 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· 40th of 51
$955
AK $3,981UT $537
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.