How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,000 · 10th to 90th $891 to $1,445
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 $758.58 Median $3,801.89 Typical High $8,511.38 | Facility | None | $758.58 | $3,801.89 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $933.25 Median $1,047.13 Typical High $1,174.90 | Professional | None | $933.25 | $1,047.13 | $1,174.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $724.44 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $660.69 | $724.44 | $741.31 |
Ambetter Setting Professional Modifier None Typical Low $891.25 Median $912.01 Typical High $977.24 | Professional | None | $891.25 | $912.01 | $977.24 |
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 $1,479.11 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,479.11 | $1,479.11 | $1,479.11 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $812.83 Median $1,318.26 Typical High $1,659.59 | Professional | 78 · Unplanned return to OR | $812.83 | $1,318.26 | $1,659.59 |
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 $891.25 Median $977.24 Typical High $1,995.26 | Professional | None | $891.25 | $977.24 | $1,995.26 |
Emblem Health Setting Professional Modifier None Typical Low $1,096.48 Median $1,479.11 Typical High $2,089.30 | Professional | None | $1,096.48 | $1,479.11 | $2,089.30 |
Geisinger Setting Professional Modifier None Typical Low $870.96 Median $1,023.29 Typical High $1,819.70 | Professional | None | $870.96 | $1,023.29 | $1,819.70 |
Highmark BCBS Setting Professional Modifier None Typical Low $912.01 Median $1,023.29 Typical High $1,445.44 | Professional | None | $912.01 | $1,023.29 | $1,445.44 |
Martin's Point Setting Facility Modifier None Typical Low $758.58 Median $3,801.89 Typical High $8,709.64 | Facility | None | $758.58 | $3,801.89 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $933.25 Median $1,023.29 Typical High $1,071.52 | Professional | None | $933.25 | $1,023.29 | $1,071.52 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $724.44 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $660.69 | $724.44 | $741.31 |
Oscar Health Setting Professional Modifier None Typical Low $977.24 Median $1,023.29 Typical High $1,905.46 | Professional | None | $977.24 | $1,023.29 | $1,905.46 |
UPMC Health Plan Setting Facility Modifier None Typical Low $954.99 Median $954.99 Typical High $977.24 | Facility | None | $954.99 | $954.99 | $977.24 |
UPMC Health Plan Setting Professional Modifier None Typical Low $954.99 Median $977.24 Typical High $1,000.00 | Professional | None | $954.99 | $977.24 | $1,000.00 |
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 $870.96 Median $1,047.13 Typical High $1,621.81 | Professional | None | $870.96 | $1,047.13 | $1,621.81 |
10 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 $467.74 Median $524.81 Typical High $537.03 | Professional | 52 · Reduced service | $467.74 | $524.81 | $537.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $190.55 Median $208.93 Typical High $213.80 | Professional | 53 · Discontinued | $190.55 | $208.93 | $213.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $707.95 Median $776.25 Typical High $794.33 | Professional | 54 · Surgery only | $707.95 | $776.25 | $794.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $141.25 Median $154.88 Typical High $158.49 | Professional | 55 · Aftercare only | $141.25 | $154.88 | $158.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $93.33 Median $104.71 Typical High $107.15 | Professional | 56 · Pre-op care only | $93.33 | $104.71 | $107.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $467.74 Median $524.81 Typical High $537.03 | Professional | 52 · Reduced service | $467.74 | $524.81 | $537.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $190.55 Median $208.93 Typical High $213.80 | Professional | 53 · Discontinued | $190.55 | $208.93 | $213.80 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $707.95 Median $776.25 Typical High $794.33 | Professional | 54 · Surgery only | $707.95 | $776.25 | $794.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $141.25 Median $154.88 Typical High $158.49 | Professional | 55 · Aftercare only | $141.25 | $154.88 | $158.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $93.33 Median $104.71 Typical High $107.15 | Professional | 56 · Pre-op care only | $93.33 | $104.71 | $107.15 |
Where Pennsylvania sits
The same service costs 10.5 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 $17,137MD $1,634
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.