How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,607Professionalmedian $1,479 · 10th to 90th $1,318 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 $758.58 Median $3,801.89 Typical High $8,511.38 | Facility | None | $758.58 | $3,801.89 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,348.96 Median $1,479.11 Typical High $1,995.26 | Professional | None | $1,348.96 | $1,479.11 | $1,995.26 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $1,000.00 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $933.25 | $1,000.00 | $1,047.13 |
Ambetter Setting Professional Modifier None Typical Low $1,995.26 Median $1,995.26 Typical High $1,995.26 | Professional | None | $1,995.26 | $1,995.26 | $1,995.26 |
AmeriHealth Setting Professional Modifier None Typical Low $1,548.82 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,548.82 | $1,548.82 | $1,548.82 |
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 $1,445.44 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,445.44 | $1,445.44 | $1,445.44 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,148.15 Median $1,862.09 Typical High $2,344.23 | Professional | 78 · Unplanned return to OR | $1,148.15 | $1,862.09 | $2,344.23 |
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 $1,318.26 Median $1,548.82 Typical High $2,818.38 | Professional | None | $1,318.26 | $1,548.82 | $2,818.38 |
Emblem Health Setting Professional Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,344.23 | Professional | None | $2,089.30 | $2,089.30 | $2,344.23 |
Geisinger Setting Professional Modifier None Typical Low $1,258.93 Median $1,737.80 Typical High $2,884.03 | Professional | None | $1,258.93 | $1,737.80 | $2,884.03 |
Highmark BCBS Setting Facility Modifier None Typical Low $10,964.78 Median $10,964.78 Typical High $10,964.78 | Facility | None | $10,964.78 | $10,964.78 | $10,964.78 |
Independence Blue Cross Setting Professional Modifier None Typical Low $1,548.82 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,548.82 | $1,548.82 | $1,548.82 |
Martin's Point Setting Facility Modifier None Typical Low $758.58 Median $3,801.89 Typical High $8,709.64 | Facility | None | $758.58 | $3,801.89 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,348.96 Median $1,479.11 Typical High $1,995.26 | Professional | None | $1,348.96 | $1,479.11 | $1,995.26 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $1,000.00 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $933.25 | $1,000.00 | $1,047.13 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $1,584.89 Typical High $2,818.38 | Professional | None | $15.14 | $1,584.89 | $2,818.38 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,348.96 Median $1,513.56 Typical High $1,513.56 | Facility | None | $1,348.96 | $1,513.56 | $1,513.56 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,348.96 Median $1,513.56 Typical High $1,513.56 | Professional | None | $1,348.96 | $1,513.56 | $1,513.56 |
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 $1,202.26 Median $1,513.56 Typical High $2,884.03 | Professional | None | $1,202.26 | $1,513.56 | $2,884.03 |
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 $660.69 Median $707.95 Typical High $741.31 | Professional | 52 · Reduced service | $660.69 | $707.95 | $741.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $288.40 Typical High $295.12 | Professional | 53 · Discontinued | $269.15 | $288.40 | $295.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,071.52 Typical High $1,122.02 | Professional | 54 · Surgery only | $1,000.00 | $1,071.52 | $1,122.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $213.80 Typical High $223.87 | Professional | 55 · Aftercare only | $199.53 | $213.80 | $223.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $144.54 Typical High $147.91 | Professional | 56 · Pre-op care only | $134.90 | $144.54 | $147.91 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $660.69 Median $707.95 Typical High $741.31 | Professional | 52 · Reduced service | $660.69 | $707.95 | $741.31 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $288.40 Typical High $295.12 | Professional | 53 · Discontinued | $269.15 | $288.40 | $295.12 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,071.52 Typical High $1,122.02 | Professional | 54 · Surgery only | $1,000.00 | $1,071.52 | $1,122.02 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $213.80 Typical High $223.87 | Professional | 55 · Aftercare only | $199.53 | $213.80 | $223.87 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $144.54 Typical High $147.91 | Professional | 56 · Pre-op care only | $134.90 | $144.54 | $147.91 |
Where Pennsylvania sits
The same service costs 13.5 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 $28,253WA $2,096
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.