How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,514 · 10th to 90th $1,202 to $2,455
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 $1,348.96 Median $1,513.56 Typical High $1,513.56 | Professional | None | $1,348.96 | $1,513.56 | $1,513.56 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $1,047.13 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $954.99 | $1,047.13 | $1,047.13 |
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 $1,258.93 Median $1,995.26 Typical High $2,630.27 | Professional | None | $1,258.93 | $1,995.26 | $2,630.27 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,621.81 Typical High $2,137.96 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,621.81 | $2,137.96 |
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 $1,202.26 Median $1,445.44 Typical High $2,570.40 | Professional | None | $1,202.26 | $1,445.44 | $2,570.40 |
Emblem Health Setting Professional Modifier None Typical Low $1,819.70 Median $1,819.70 Typical High $2,041.74 | Professional | None | $1,819.70 | $1,819.70 | $2,041.74 |
Geisinger Setting Professional Modifier None Typical Low $1,202.26 Median $1,737.80 Typical High $2,884.03 | Professional | None | $1,202.26 | $1,737.80 | $2,884.03 |
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 $1,348.96 Median $1,513.56 Typical High $1,513.56 | Professional | None | $1,348.96 | $1,513.56 | $1,513.56 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $1,047.13 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $954.99 | $1,047.13 | $1,047.13 |
Oscar Health Setting Professional Modifier None Typical Low $1,479.11 Median $1,479.11 Typical High $2,818.38 | Professional | None | $1,479.11 | $1,479.11 | $2,818.38 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,230.27 Median $1,659.59 Typical High $1,659.59 | Facility | None | $1,230.27 | $1,659.59 | $1,659.59 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,230.27 Median $1,288.25 Typical High $1,659.59 | Professional | None | $1,230.27 | $1,288.25 | $1,659.59 |
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 $1,174.90 Median $1,659.59 Typical High $2,630.27 | Professional | None | $1,174.90 | $1,659.59 | $2,630.27 |
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 $676.08 Median $758.58 Typical High $758.58 | Professional | 52 · Reduced service | $676.08 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $302.00 Typical High $302.00 | Professional | 53 · Discontinued | $269.15 | $302.00 | $302.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,122.02 Typical High $1,122.02 | Professional | 54 · Surgery only | $1,023.29 | $1,122.02 | $1,122.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $223.87 Typical High $223.87 | Professional | 55 · Aftercare only | $204.17 | $223.87 | $223.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $151.36 Typical High $151.36 | Professional | 56 · Pre-op care only | $134.90 | $151.36 | $151.36 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,862.09 Median $2,884.03 Typical High $3,801.89 | Professional | 50 · Both sides | $1,862.09 | $2,884.03 | $3,801.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $676.08 Median $758.58 Typical High $758.58 | Professional | 52 · Reduced service | $676.08 | $758.58 | $758.58 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $302.00 Typical High $302.00 | Professional | 53 · Discontinued | $269.15 | $302.00 | $302.00 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,122.02 Typical High $1,122.02 | Professional | 54 · Surgery only | $1,023.29 | $1,122.02 | $1,122.02 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $223.87 Typical High $223.87 | Professional | 55 · Aftercare only | $204.17 | $223.87 | $223.87 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $151.36 Typical High $151.36 | Professional | 56 · Pre-op care only | $134.90 | $151.36 | $151.36 |
Where Pennsylvania sits
The same service costs 8.1 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 $15,945MD $1,975
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.