How much rates vary
Facilitymedian $851 · 10th to 90th $316 to $7,079Professionalmedian $933 · 10th to 90th $759 to $1,549
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 $933.25 Median $4,897.79 Typical High $8,511.38 | Facility | None | $933.25 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $776.25 Median $933.25 Typical High $933.25 | Professional | None | $776.25 | $933.25 | $933.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $660.69 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $588.84 | $660.69 | $660.69 |
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 $776.25 Median $1,348.96 Typical High $1,659.59 | Professional | None | $776.25 | $1,348.96 | $1,659.59 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $1,122.02 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $660.69 | $1,122.02 | $1,380.38 |
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 $758.58 Median $912.01 Typical High $1,584.89 | Professional | None | $758.58 | $912.01 | $1,584.89 |
Emblem Health Setting Professional Modifier None Typical Low $1,122.02 Median $1,122.02 Typical High $1,258.93 | Professional | None | $1,122.02 | $1,122.02 | $1,258.93 |
Geisinger Setting Professional Modifier None Typical Low $794.33 Median $1,071.52 Typical High $1,584.89 | Professional | None | $794.33 | $1,071.52 | $1,584.89 |
Martin's Point Setting Facility Modifier None Typical Low $933.25 Median $4,786.30 Typical High $8,511.38 | Facility | None | $933.25 | $4,786.30 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $776.25 Median $933.25 Typical High $933.25 | Professional | None | $776.25 | $933.25 | $933.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $660.69 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $588.84 | $660.69 | $660.69 |
Oscar Health Setting Professional Modifier None Typical Low $870.96 Median $870.96 Typical High $891.25 | Professional | None | $870.96 | $870.96 | $891.25 |
UPMC Health Plan Setting Facility Modifier None Typical Low $758.58 Median $912.01 Typical High $912.01 | Facility | None | $758.58 | $912.01 | $912.01 |
UPMC Health Plan Setting Professional Modifier None Typical Low $758.58 Median $794.33 Typical High $912.01 | Professional | None | $758.58 | $794.33 | $912.01 |
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 $741.31 Median $1,047.13 Typical High $1,659.59 | Professional | None | $741.31 | $1,047.13 | $1,659.59 |
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 $426.58 Median $467.74 Typical High $467.74 | Professional | 52 · Reduced service | $426.58 | $467.74 | $467.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $186.21 Typical High $186.21 | Professional | 53 · Discontinued | $169.82 | $186.21 | $186.21 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $707.95 Typical High $707.95 | Professional | 54 · Surgery only | $630.96 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $141.25 Typical High $141.25 | Professional | 55 · Aftercare only | $125.89 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $93.33 Typical High $93.33 | Professional | 56 · Pre-op care only | $85.11 | $93.33 | $93.33 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $426.58 Median $467.74 Typical High $467.74 | Professional | 52 · Reduced service | $426.58 | $467.74 | $467.74 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $186.21 Typical High $186.21 | Professional | 53 · Discontinued | $169.82 | $186.21 | $186.21 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $707.95 Typical High $707.95 | Professional | 54 · Surgery only | $630.96 | $707.95 | $707.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $141.25 Typical High $141.25 | Professional | 55 · Aftercare only | $125.89 | $141.25 | $141.25 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $93.33 Typical High $93.33 | Professional | 56 · Pre-op care only | $85.11 | $93.33 | $93.33 |
Where Pennsylvania sits
The same service costs 18.7 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 $26,826MD $1,433
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.