How much rates vary
Facilitymedian $9,772 · 10th to 90th $3,388 to $251,189Professionalmedian $4,467 · 10th to 90th $1,349 to $7,413
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $2,344.23 Median $10,000.00 Typical High $20,417.38 | Facility | None | $2,344.23 | $10,000.00 | $20,417.38 |
Aetna Setting Professional Modifier None Typical Low $1,318.26 Median $6,760.83 Typical High $7,413.10 | Professional | None | $1,318.26 | $6,760.83 | $7,413.10 |
Cigna Setting Professional Modifier None Typical Low $1,230.27 Median $1,905.46 Typical High $4,168.69 | Professional | None | $1,230.27 | $1,905.46 | $4,168.69 |
Moda Health Setting Facility Modifier None Typical Low $2,187.76 Median $7,413.10 Typical High $10,471.29 | Facility | None | $2,187.76 | $7,413.10 | $10,471.29 |
Moda Health Setting Professional Modifier None Typical Low $1,348.96 Median $4,786.30 Typical High $8,128.31 | Professional | None | $1,348.96 | $4,786.30 | $8,128.31 |
Premera BCBS Setting Professional Modifier None Typical Low $5,623.41 Median $5,623.41 Typical High $5,623.41 | Professional | None | $5,623.41 | $5,623.41 | $5,623.41 |
Providence Setting Facility Modifier None Typical Low $7,413.10 Median $251,188.64 Typical High $346,736.85 | Facility | None | $7,413.10 | $251,188.64 | $346,736.85 |
Providence Setting Professional Modifier None Typical Low $60.26 Median $1,949.84 Typical High $4,168.69 | Professional | None | $60.26 | $1,949.84 | $4,168.69 |
United Setting Facility Modifier None Typical Low $3,388.44 Median $7,585.78 Typical High $19,498.45 | Facility | None | $3,388.44 | $7,585.78 | $19,498.45 |
United Setting Professional Modifier None Typical Low $1,288.25 Median $3,715.35 Typical High $8,511.38 | Professional | None | $1,288.25 | $3,715.35 | $8,511.38 |
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 $676.08 Median $3,630.78 Typical High $3,630.78 | Professional | 52 · Reduced service | $676.08 | $3,630.78 | $3,630.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $1,479.11 Typical High $1,479.11 | Professional | 53 · Discontinued | $269.15 | $1,479.11 | $1,479.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $5,495.41 Typical High $5,495.41 | Professional | 54 · Surgery only | $1,023.29 | $5,495.41 | $5,495.41 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $1,096.48 Typical High $1,096.48 | Professional | 55 · Aftercare only | $204.17 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $741.31 Typical High $741.31 | Professional | 56 · Pre-op care only | $134.90 | $741.31 | $741.31 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $5,128.61 Typical High $5,128.61 | Professional | 78 · Unplanned return to OR | $954.99 | $5,128.61 | $5,128.61 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $741.31 Median $3,630.78 Typical High $3,630.78 | Professional | 52 · Reduced service | $741.31 | $3,630.78 | $3,630.78 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $1,479.11 Typical High $1,479.11 | Professional | 53 · Discontinued | $295.12 | $1,479.11 | $1,479.11 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $5,495.41 Typical High $5,495.41 | Professional | 54 · Surgery only | $1,122.02 | $5,495.41 | $5,495.41 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $1,096.48 Typical High $1,096.48 | Professional | 55 · Aftercare only | $223.87 | $1,096.48 | $1,096.48 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $741.31 Typical High $741.31 | Professional | 56 · Pre-op care only | $147.91 | $741.31 | $741.31 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $5,128.61 Typical High $5,128.61 | Professional | 78 · Unplanned return to OR | $1,047.13 | $5,128.61 | $5,128.61 |
Where Alaska sits
The same service costs 8.5 times more in Maine than in Delaware. 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 $28,081DE $3,299
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.