How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,622 · 10th to 90th $1,288 to $2,630
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 $1,445.44 Median $1,584.89 Typical High $1,621.81 | Professional | None | $1,445.44 | $1,584.89 | $1,621.81 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,122.02 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,122.02 | $1,122.02 |
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 $1,318.26 Median $2,137.96 Typical High $2,818.38 | Professional | None | $1,318.26 | $2,137.96 | $2,818.38 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,737.80 Typical High $2,290.87 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,737.80 | $2,290.87 |
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 $1,258.93 Median $1,548.82 Typical High $2,754.23 | Professional | None | $1,258.93 | $1,548.82 | $2,754.23 |
Emblem Health Setting Professional Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $2,137.96 | Professional | None | $1,905.46 | $1,905.46 | $2,137.96 |
Geisinger Setting Professional Modifier None Typical Low $1,412.54 Median $1,778.28 Typical High $3,019.95 | Professional | None | $1,412.54 | $1,778.28 | $3,019.95 |
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 $1,445.44 Median $1,584.89 Typical High $1,621.81 | Professional | None | $1,445.44 | $1,584.89 | $1,621.81 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,122.02 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,122.02 | $1,122.02 |
Oscar Health Setting Professional Modifier None Typical Low $1,548.82 Median $1,548.82 Typical High $2,951.21 | Professional | None | $1,548.82 | $1,548.82 | $2,951.21 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,318.26 Median $1,737.80 Typical High $1,737.80 | Facility | None | $1,318.26 | $1,737.80 | $1,737.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,318.26 Median $1,380.38 Typical High $1,737.80 | Professional | None | $1,318.26 | $1,380.38 | $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 $1,258.93 Median $1,778.28 Typical High $2,818.38 | Professional | None | $1,258.93 | $1,778.28 | $2,818.38 |
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 $724.44 Median $794.33 Typical High $794.33 | Professional | 52 · Reduced service | $724.44 | $794.33 | $794.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $288.40 Median $323.59 Typical High $323.59 | Professional | 53 · Discontinued | $288.40 | $323.59 | $323.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,202.26 Typical High $1,202.26 | Professional | 54 · Surgery only | $1,071.52 | $1,202.26 | $1,202.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $239.88 Typical High $239.88 | Professional | 55 · Aftercare only | $213.80 | $239.88 | $239.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $144.54 Median $158.49 Typical High $162.18 | Professional | 56 · Pre-op care only | $144.54 | $158.49 | $162.18 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,949.84 Median $3,090.30 Typical High $4,073.80 | Professional | 50 · Both sides | $1,949.84 | $3,090.30 | $4,073.80 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $724.44 Median $794.33 Typical High $794.33 | Professional | 52 · Reduced service | $724.44 | $794.33 | $794.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $288.40 Median $323.59 Typical High $323.59 | Professional | 53 · Discontinued | $288.40 | $323.59 | $323.59 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,202.26 Typical High $1,202.26 | Professional | 54 · Surgery only | $1,071.52 | $1,202.26 | $1,202.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $239.88 Typical High $239.88 | Professional | 55 · Aftercare only | $213.80 | $239.88 | $239.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $144.54 Median $158.49 Typical High $162.18 | Professional | 56 · Pre-op care only | $144.54 | $158.49 | $162.18 |
Where Pennsylvania sits
The same service costs 7.5 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 $16,075MD $2,147
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.