How much rates vary
Facilitymedian $794 · 10th to 90th $302 to $8,511Professionalmedian $1,259 · 10th to 90th $1,122 to $1,995
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 $1,148.15 Median $1,258.93 Typical High $1,258.93 | Professional | None | $1,148.15 | $1,258.93 | $1,258.93 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $851.14 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $794.33 | $851.14 | $870.96 |
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 $1,905.46 Median $1,905.46 Typical High $56,234.13 | Professional | None | $1,905.46 | $1,905.46 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $1,479.11 Typical High $1,778.28 | Professional | 78 · Unplanned return to OR | $912.01 | $1,479.11 | $1,778.28 |
Cigna Setting Facility Modifier None Typical Low $120.23 Median $676.08 Typical High $2,290.87 | Facility | None | $120.23 | $676.08 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,122.02 Median $1,230.27 Typical High $2,187.76 | Professional | None | $1,122.02 | $1,230.27 | $2,187.76 |
Emblem Health Setting Professional Modifier None Typical Low $1,621.81 Median $1,621.81 Typical High $1,737.80 | Professional | None | $1,621.81 | $1,621.81 | $1,737.80 |
Geisinger Setting Professional Modifier None Typical Low $1,047.13 Median $1,412.54 Typical High $2,344.23 | Professional | None | $1,047.13 | $1,412.54 | $2,344.23 |
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 $1,148.15 Median $1,258.93 Typical High $1,258.93 | Professional | None | $1,148.15 | $1,258.93 | $1,258.93 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $851.14 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $794.33 | $851.14 | $870.96 |
Oscar Health Setting Professional Modifier None Typical Low $18.20 Median $1,513.56 Typical High $2,344.23 | Professional | None | $18.20 | $1,513.56 | $2,344.23 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,174.90 Median $7,079.46 Typical High $11,220.18 | Facility | None | $1,174.90 | $7,079.46 | $11,220.18 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,174.90 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,174.90 | $1,479.11 | $1,479.11 |
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 $1,023.29 Median $1,258.93 Typical High $2,398.83 | Professional | None | $1,023.29 | $1,258.93 | $2,398.83 |
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 $562.34 Median $602.56 Typical High $630.96 | Professional | 52 · Reduced service | $562.34 | $602.56 | $630.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $245.47 Typical High $251.19 | Professional | 53 · Discontinued | $229.09 | $245.47 | $251.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $912.01 Typical High $933.25 | Professional | 54 · Surgery only | $851.14 | $912.01 | $933.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $181.97 Typical High $186.21 | Professional | 55 · Aftercare only | $169.82 | $181.97 | $186.21 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $123.03 Typical High $125.89 | Professional | 56 · Pre-op care only | $114.82 | $123.03 | $125.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $562.34 Median $602.56 Typical High $630.96 | Professional | 52 · Reduced service | $562.34 | $602.56 | $630.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $245.47 Typical High $251.19 | Professional | 53 · Discontinued | $229.09 | $245.47 | $251.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $912.01 Typical High $933.25 | Professional | 54 · Surgery only | $851.14 | $912.01 | $933.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $181.97 Typical High $186.21 | Professional | 55 · Aftercare only | $169.82 | $181.97 | $186.21 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $123.03 Typical High $125.89 | Professional | 56 · Pre-op care only | $114.82 | $123.03 | $125.89 |
Where Pennsylvania sits
The same service costs 15.8 times more in Maine than in Washington. 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.
Physician feeFacility fee
ME $28,537WA $1,809
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.