How much rates vary
Facilitymedian $2,291 · 10th to 90th $575 to $7,079Professionalmedian $1,096 · 10th to 90th $977 to $1,514
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 $1,047.13 Median $1,148.15 Typical High $1,174.90 | Professional | None | $1,047.13 | $1,148.15 | $1,174.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $812.83 Typical High $812.83 | Professional | 78 · Unplanned return to OR | $724.44 | $812.83 | $812.83 |
Ambetter Setting Professional Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,412.54 | $1,412.54 | $1,412.54 |
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 $1,621.81 Median $1,621.81 Typical High $1,621.81 | Professional | None | $1,621.81 | $1,621.81 | $1,621.81 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $891.25 Median $1,445.44 Typical High $1,819.70 | Professional | 78 · Unplanned return to OR | $891.25 | $1,445.44 | $1,819.70 |
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 $1,071.52 Typical High $2,187.76 | Professional | None | $977.24 | $1,071.52 | $2,187.76 |
Emblem Health Setting Professional Modifier None Typical Low $1,230.27 Median $1,621.81 Typical High $2,137.96 | Professional | None | $1,230.27 | $1,621.81 | $2,137.96 |
Geisinger Setting Professional Modifier None Typical Low $954.99 Median $1,096.48 Typical High $1,995.26 | Professional | None | $954.99 | $1,096.48 | $1,995.26 |
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 $1,047.13 Median $1,148.15 Typical High $1,174.90 | Professional | None | $1,047.13 | $1,148.15 | $1,174.90 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $812.83 Typical High $812.83 | Professional | 78 · Unplanned return to OR | $724.44 | $812.83 | $812.83 |
Oscar Health Setting Professional Modifier None Typical Low $1,047.13 Median $1,096.48 Typical High $2,089.30 | Professional | None | $1,047.13 | $1,096.48 | $2,089.30 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,096.48 Median $1,096.48 Typical High $1,096.48 | Facility | None | $1,096.48 | $1,096.48 | $1,096.48 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,096.48 Median $1,096.48 Typical High $1,096.48 | Professional | None | $1,096.48 | $1,096.48 | $1,096.48 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,162.28 Typical High $7,079.46 | Facility | None | $1,698.24 | $3,162.28 | $7,079.46 |
United Setting Professional Modifier None Typical Low $954.99 Median $1,148.15 Typical High $1,819.70 | Professional | None | $954.99 | $1,148.15 | $1,819.70 |
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 $524.81 Median $575.44 Typical High $588.84 | Professional | 52 · Reduced service | $524.81 | $575.44 | $588.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $208.93 Median $229.09 Typical High $234.42 | Professional | 53 · Discontinued | $208.93 | $229.09 | $234.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $870.96 Typical High $870.96 | Professional | 54 · Surgery only | $776.25 | $870.96 | $870.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $154.88 Median $173.78 Typical High $177.83 | Professional | 55 · Aftercare only | $154.88 | $173.78 | $177.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $104.71 Median $114.82 Typical High $117.49 | Professional | 56 · Pre-op care only | $104.71 | $114.82 | $117.49 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $524.81 Median $575.44 Typical High $588.84 | Professional | 52 · Reduced service | $524.81 | $575.44 | $588.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $208.93 Median $229.09 Typical High $234.42 | Professional | 53 · Discontinued | $208.93 | $229.09 | $234.42 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $870.96 Typical High $870.96 | Professional | 54 · Surgery only | $776.25 | $870.96 | $870.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $154.88 Median $173.78 Typical High $177.83 | Professional | 55 · Aftercare only | $154.88 | $173.78 | $177.83 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $104.71 Median $114.82 Typical High $117.49 | Professional | 56 · Pre-op care only | $104.71 | $114.82 | $117.49 |
Where Pennsylvania sits
The same service costs 5.4 times more in Maine than in Texas. 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 $13,748TX $2,544
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.