How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,166Professionalmedian $1,288 · 10th to 90th $1,072 to $2,399
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 $1,122.02 Median $1,230.27 Typical High $1,412.54 | Professional | None | $1,122.02 | $1,230.27 | $1,412.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $870.96 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $794.33 | $870.96 | $1,000.00 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $5,011.87 Typical High $56,234.13 | Facility | None | $3,981.07 | $5,011.87 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $1,230.27 Median $1,862.09 Typical High $2,454.71 | Professional | None | $1,230.27 | $1,862.09 | $2,454.71 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,513.56 Typical High $1,995.26 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,513.56 | $1,995.26 |
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 $1,071.52 Median $1,071.52 Typical High $1,071.52 | Professional | None | $1,071.52 | $1,071.52 | $1,071.52 |
Emblem Health Setting Professional Modifier None Typical Low $1,380.38 Median $1,862.09 Typical High $2,630.27 | Professional | None | $1,380.38 | $1,862.09 | $2,630.27 |
Geisinger Setting Professional Modifier None Typical Low $1,148.15 Median $1,445.44 Typical High $2,187.76 | Professional | None | $1,148.15 | $1,445.44 | $2,187.76 |
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 $1,122.02 Median $1,258.93 Typical High $1,412.54 | Professional | None | $1,122.02 | $1,258.93 | $1,412.54 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $891.25 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $794.33 | $891.25 | $1,000.00 |
Oscar Health Setting Professional Modifier None Typical Low $1,737.80 Median $2,344.23 Typical High $2,344.23 | Professional | None | $1,737.80 | $2,344.23 | $2,344.23 |
UPMC Health Plan Setting Facility Modifier None Typical Low $977.24 Median $977.24 Typical High $1,202.26 | Facility | None | $977.24 | $977.24 | $1,202.26 |
UPMC Health Plan Setting Professional Modifier None Typical Low $977.24 Median $1,202.26 Typical High $1,230.27 | Professional | None | $977.24 | $1,202.26 | $1,230.27 |
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 $977.24 Median $1,148.15 Typical High $1,819.70 | Professional | None | $977.24 | $1,148.15 | $1,819.70 |
6 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 54 · Surgery only Typical Low $851.14 Median $933.25 Typical High $1,071.52 | Professional | 54 · Surgery only | $851.14 | $933.25 | $1,071.52 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $186.21 Typical High $213.80 | Professional | 55 · Aftercare only | $169.82 | $186.21 | $213.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $123.03 Typical High $141.25 | Professional | 56 · Pre-op care only | $112.20 | $123.03 | $141.25 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $954.99 Typical High $1,071.52 | Professional | 54 · Surgery only | $851.14 | $954.99 | $1,071.52 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $190.55 Typical High $213.80 | Professional | 55 · Aftercare only | $169.82 | $190.55 | $213.80 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $125.89 Typical High $141.25 | Professional | 56 · Pre-op care only | $112.20 | $125.89 | $141.25 |
Where Pennsylvania sits
The same service costs 16.2 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· 25th of 51
$1,288
AK $3,090TX $191
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.