How much rates vary
Facilitymedian $891 · 10th to 90th $316 to $8,128Professionalmedian $1,820 · 10th to 90th $1,445 to $2,951
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 $1,071.52 Median $5,495.41 Typical High $9,332.54 | Facility | None | $1,071.52 | $5,495.41 | $9,332.54 |
Aetna Setting Professional Modifier None Typical Low $1,445.44 Median $1,819.70 Typical High $2,238.72 | Professional | None | $1,445.44 | $1,819.70 | $2,238.72 |
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 $1,479.11 Median $2,570.40 Typical High $3,162.28 | Professional | None | $1,479.11 | $2,570.40 | $3,162.28 |
Cigna Setting Facility Modifier None Typical Low $380.19 Median $645.65 Typical High $2,290.87 | Facility | None | $380.19 | $645.65 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,445.44 Median $1,737.80 Typical High $3,019.95 | Professional | None | $1,445.44 | $1,737.80 | $3,019.95 |
Emblem Health Setting Professional Modifier None Typical Low $2,137.96 Median $2,137.96 Typical High $2,398.83 | Professional | None | $2,137.96 | $2,137.96 | $2,398.83 |
Geisinger Setting Professional Modifier None Typical Low $1,513.56 Median $2,041.74 Typical High $3,019.95 | Professional | None | $1,513.56 | $2,041.74 | $3,019.95 |
Highmark BCBS Setting Professional Modifier None Typical Low $1,659.59 Median $1,778.28 Typical High $1,819.70 | Professional | None | $1,659.59 | $1,778.28 | $1,819.70 |
Martin's Point Setting Facility Modifier None Typical Low $1,071.52 Median $5,128.61 Typical High $9,772.37 | Facility | None | $1,071.52 | $5,128.61 | $9,772.37 |
Martin's Point Setting Professional Modifier None Typical Low $1,445.44 Median $1,819.70 Typical High $2,398.83 | Professional | None | $1,445.44 | $1,819.70 | $2,398.83 |
Oscar Health Setting Professional Modifier None Typical Low $1,659.59 Median $1,659.59 Typical High $1,698.24 | Professional | None | $1,659.59 | $1,659.59 | $1,698.24 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,479.11 Median $1,737.80 Typical High $1,737.80 | Facility | None | $1,479.11 | $1,737.80 | $1,737.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,479.11 Median $1,548.82 Typical High $1,737.80 | Professional | None | $1,479.11 | $1,548.82 | $1,737.80 |
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 $1,412.54 Median $1,995.26 Typical High $3,162.28 | Professional | None | $1,412.54 | $1,995.26 | $3,162.28 |
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 $812.83 Median $912.01 Typical High $912.01 | Professional | 52 · Reduced service | $812.83 | $912.01 | $912.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $363.08 Typical High $363.08 | Professional | 53 · Discontinued | $323.59 | $363.08 | $363.08 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,230.27 Median $1,348.96 Typical High $1,348.96 | Professional | 54 · Surgery only | $1,230.27 | $1,348.96 | $1,348.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $245.47 Median $269.15 Typical High $269.15 | Professional | 55 · Aftercare only | $245.47 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $181.97 Typical High $181.97 | Professional | 56 · Pre-op care only | $162.18 | $181.97 | $181.97 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $2,137.96 Typical High $2,630.27 | Professional | 78 · Unplanned return to OR | $1,258.93 | $2,137.96 | $2,630.27 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $812.83 Median $912.01 Typical High $912.01 | Professional | 52 · Reduced service | $812.83 | $912.01 | $912.01 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $363.08 Typical High $363.08 | Professional | 53 · Discontinued | $323.59 | $363.08 | $363.08 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,230.27 Median $1,348.96 Typical High $1,348.96 | Professional | 54 · Surgery only | $1,230.27 | $1,348.96 | $1,348.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $245.47 Median $269.15 Typical High $269.15 | Professional | 55 · Aftercare only | $245.47 | $269.15 | $269.15 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $181.97 Typical High $181.97 | Professional | 56 · Pre-op care only | $162.18 | $181.97 | $181.97 |
Where Pennsylvania sits
The same service costs 24.1 times more in Maine than in Maryland. 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 $53,525MD $2,222
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.