How much rates vary
Facilitymedian $2,884 · 10th to 90th $603 to $6,607Professionalmedian $3,631 · 10th to 90th $1,862 to $5,370
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 $2,884.03 Median $5,888.44 Typical High $7,943.28 | Facility | None | $2,884.03 | $5,888.44 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $1,584.89 Median $2,884.03 Typical High $2,884.03 | Professional | None | $1,584.89 | $2,884.03 | $2,884.03 |
Cigna Setting Professional Modifier None Typical Low $1,819.70 Median $3,981.07 Typical High $4,786.30 | Professional | None | $1,819.70 | $3,981.07 | $4,786.30 |
Hally Health Setting Professional Modifier None Typical Low $1,621.81 Median $2,238.72 Typical High $4,897.79 | Professional | None | $1,621.81 | $2,238.72 | $4,897.79 |
Medica Setting Facility Modifier None Typical Low $588.84 Median $2,754.23 Typical High $5,011.87 | Facility | None | $588.84 | $2,754.23 | $5,011.87 |
Medica Setting Professional Modifier None Typical Low $1,995.26 Median $3,890.45 Typical High $12,882.50 | Professional | None | $1,995.26 | $3,890.45 | $12,882.50 |
Midlands Setting Professional Modifier None Typical Low $3,890.45 Median $3,981.07 Typical High $4,786.30 | Professional | None | $3,890.45 | $3,981.07 | $4,786.30 |
Midlands Setting Professional Modifier None Typical Low $3,090.30 Median $4,365.16 Typical High $4,786.30 | Professional | None | $3,090.30 | $4,365.16 | $4,786.30 |
Oscar Health Setting Professional Modifier None Typical Low $1,737.80 Median $3,235.94 Typical High $4,073.80 | Professional | None | $1,737.80 | $3,235.94 | $4,073.80 |
United Setting Facility Modifier None Typical Low $588.84 Median $2,344.23 Typical High $6,918.31 | Facility | None | $588.84 | $2,344.23 | $6,918.31 |
United Setting Professional Modifier None Typical Low $1,778.28 Median $2,511.89 Typical High $4,786.30 | Professional | None | $1,778.28 | $2,511.89 | $4,786.30 |
Wellmark Setting Professional Modifier None Typical Low $3,630.78 Median $3,630.78 Typical High $3,981.07 | Professional | None | $3,630.78 | $3,630.78 | $3,981.07 |
6 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 $794.33 Median $1,445.44 Typical High $1,445.44 | Professional | 52 · Reduced service | $794.33 | $1,445.44 | $1,445.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $575.44 Typical High $575.44 | Professional | 53 · Discontinued | $316.23 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $2,137.96 Typical High $2,137.96 | Professional | 54 · Surgery only | $1,174.90 | $2,137.96 | $2,137.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $426.58 Typical High $426.58 | Professional | 55 · Aftercare only | $239.88 | $426.58 | $426.58 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $288.40 Typical High $288.40 | Professional | 56 · Pre-op care only | $158.49 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,995.26 Typical High $1,995.26 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,995.26 | $1,995.26 |
Where Iowa sits
The same service costs 7.6 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 $18,140MD $2,382
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.