How much rates vary
Facilitymedian $11,220 · 10th to 90th $1,000 to $251,189Professionalmedian $7,244 · 10th to 90th $2,138 to $11,220
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 $9,772.37 Median $12,022.64 Typical High $16,595.87 | Facility | None | $9,772.37 | $12,022.64 | $16,595.87 |
Aetna Setting Professional Modifier None Typical Low $2,089.30 Median $11,220.18 Typical High $11,220.18 | Professional | None | $2,089.30 | $11,220.18 | $11,220.18 |
Cigna Setting Professional Modifier None Typical Low $1,862.09 Median $2,951.21 Typical High $6,456.54 | Professional | None | $1,862.09 | $2,951.21 | $6,456.54 |
Moda Health Setting Facility Modifier None Typical Low $3,311.31 Median $11,220.18 Typical High $16,218.10 | Facility | None | $3,311.31 | $11,220.18 | $16,218.10 |
Moda Health Setting Professional Modifier None Typical Low $2,344.23 Median $8,709.64 Typical High $12,589.25 | Professional | None | $2,344.23 | $8,709.64 | $12,589.25 |
Premera BCBS Setting Professional Modifier None Typical Low $8,709.64 Median $8,709.64 Typical High $8,709.64 | Professional | None | $8,709.64 | $8,709.64 | $8,709.64 |
Providence Setting Facility Modifier None Typical Low $11,220.18 Median $251,188.64 Typical High $346,736.85 | Facility | None | $11,220.18 | $251,188.64 | $346,736.85 |
Providence Setting Professional Modifier None Typical Low $60.26 Median $3,019.95 Typical High $6,456.54 | Professional | None | $60.26 | $3,019.95 | $6,456.54 |
United Setting Facility Modifier None Typical Low $691.83 Median $1,071.52 Typical High $4,265.80 | Facility | None | $691.83 | $1,071.52 | $4,265.80 |
United Setting Professional Modifier None Typical Low $2,041.74 Median $5,754.40 Typical High $13,182.57 | Professional | None | $2,041.74 | $5,754.40 | $13,182.57 |
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 $1,047.13 Median $5,623.41 Typical High $5,623.41 | Professional | 52 · Reduced service | $1,047.13 | $5,623.41 | $5,623.41 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $416.87 Median $2,238.72 Typical High $2,238.72 | Professional | 53 · Discontinued | $416.87 | $2,238.72 | $2,238.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,548.82 Median $8,511.38 Typical High $8,511.38 | Professional | 54 · Surgery only | $1,548.82 | $8,511.38 | $8,511.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $316.23 Median $1,698.24 Typical High $1,698.24 | Professional | 55 · Aftercare only | $316.23 | $1,698.24 | $1,698.24 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $208.93 Median $1,122.02 Typical High $1,122.02 | Professional | 56 · Pre-op care only | $208.93 | $1,122.02 | $1,122.02 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $7,943.28 Typical High $7,943.28 | Professional | 78 · Unplanned return to OR | $1,445.44 | $7,943.28 | $7,943.28 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1,148.15 Median $5,623.41 Typical High $5,623.41 | Professional | 52 · Reduced service | $1,148.15 | $5,623.41 | $5,623.41 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $467.74 Median $2,238.72 Typical High $2,238.72 | Professional | 53 · Discontinued | $467.74 | $2,238.72 | $2,238.72 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $1,737.80 Median $8,511.38 Typical High $8,511.38 | Professional | 54 · Surgery only | $1,737.80 | $8,511.38 | $8,511.38 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $346.74 Median $1,698.24 Typical High $1,698.24 | Professional | 55 · Aftercare only | $346.74 | $1,698.24 | $1,698.24 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $234.42 Median $1,122.02 Typical High $1,122.02 | Professional | 56 · Pre-op care only | $234.42 | $1,122.02 | $1,122.02 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,621.81 Median $7,943.28 Typical High $7,943.28 | Professional | 78 · Unplanned return to OR | $1,621.81 | $7,943.28 | $7,943.28 |
Where Alaska sits
The same service costs 7.6 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 $18,667TX $2,469
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.