How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,148 · 10th to 90th $977 to $1,622
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 $1,023.29 Median $1,148.15 Typical High $1,202.26 | Professional | None | $1,023.29 | $1,148.15 | $1,202.26 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $794.33 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $724.44 | $794.33 | $794.33 |
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 $1,698.24 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,698.24 | $1,698.24 | $1,698.24 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $831.76 Median $1,412.54 Typical High $1,698.24 | Professional | 78 · Unplanned return to OR | $831.76 | $1,412.54 | $1,698.24 |
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 $977.24 Median $1,122.02 Typical High $2,290.87 | Professional | None | $977.24 | $1,122.02 | $2,290.87 |
Emblem Health Setting Professional Modifier None Typical Low $1,288.25 Median $1,737.80 Typical High $2,398.83 | Professional | None | $1,288.25 | $1,737.80 | $2,398.83 |
Geisinger Setting Professional Modifier None Typical Low $912.01 Median $1,148.15 Typical High $2,041.74 | Professional | None | $912.01 | $1,148.15 | $2,041.74 |
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 $1,023.29 Median $1,148.15 Typical High $1,202.26 | Professional | None | $1,023.29 | $1,148.15 | $1,202.26 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $794.33 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $724.44 | $794.33 | $794.33 |
Oscar Health Setting Professional Modifier None Typical Low $933.25 Median $977.24 Typical High $2,137.96 | Professional | None | $933.25 | $977.24 | $2,137.96 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,047.13 Median $1,047.13 Typical High $1,122.02 | Facility | None | $1,047.13 | $1,047.13 | $1,122.02 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,047.13 Median $1,122.02 Typical High $1,148.15 | Professional | None | $1,047.13 | $1,122.02 | $1,148.15 |
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 $1,000.00 Median $1,230.27 Typical High $1,862.09 | Professional | None | $1,000.00 | $1,230.27 | $1,862.09 |
12 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 $512.86 Median $575.44 Typical High $575.44 | Professional | 52 · Reduced service | $512.86 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $204.17 Median $229.09 Typical High $229.09 | Professional | 53 · Discontinued | $204.17 | $229.09 | $229.09 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $851.14 Typical High $851.14 | Professional | 54 · Surgery only | $776.25 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $154.88 Median $173.78 Typical High $173.78 | Professional | 55 · Aftercare only | $154.88 | $173.78 | $173.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $102.33 Median $114.82 Typical High $114.82 | Professional | 56 · Pre-op care only | $102.33 | $114.82 | $114.82 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $954.99 Median $954.99 Typical High $954.99 | Professional | 59 · Distinct service | $954.99 | $954.99 | $954.99 |
Highmark BCBS Setting Professional Modifier GC · Resident with teaching physician Typical Low $1,047.13 Median $1,047.13 Typical High $1,737.80 | Professional | GC · Resident with teaching physician | $1,047.13 | $1,047.13 | $1,737.80 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $512.86 Median $575.44 Typical High $575.44 | Professional | 52 · Reduced service | $512.86 | $575.44 | $575.44 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $204.17 Median $229.09 Typical High $229.09 | Professional | 53 · Discontinued | $204.17 | $229.09 | $229.09 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $851.14 Typical High $851.14 | Professional | 54 · Surgery only | $776.25 | $851.14 | $851.14 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $154.88 Median $173.78 Typical High $173.78 | Professional | 55 · Aftercare only | $154.88 | $173.78 | $173.78 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $102.33 Median $114.82 Typical High $114.82 | Professional | 56 · Pre-op care only | $102.33 | $114.82 | $114.82 |
Where Pennsylvania sits
The same service costs 12.2 times more in Maine than in Florida. 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 $17,328FL $1,425
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.