How much rates vary
Facilitymedian $8,128 · 10th to 90th $1,000 to $251,189Professionalmedian $5,370 · 10th to 90th $1,549 to $8,128
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 $8,128.31 Median $12,022.64 Typical High $16,595.87 | Facility | None | $8,128.31 | $12,022.64 | $16,595.87 |
Aetna Setting Professional Modifier None Typical Low $1,513.56 Median $8,128.31 Typical High $8,128.31 | Professional | None | $1,513.56 | $8,128.31 | $8,128.31 |
Cigna Setting Professional Modifier None Typical Low $1,348.96 Median $2,137.96 Typical High $4,677.35 | Professional | None | $1,348.96 | $2,137.96 | $4,677.35 |
Moda Health Setting Facility Modifier None Typical Low $2,454.71 Median $8,128.31 Typical High $11,748.98 | Facility | None | $2,454.71 | $8,128.31 | $11,748.98 |
Moda Health Setting Professional Modifier None Typical Low $1,659.59 Median $6,309.57 Typical High $9,120.11 | Professional | None | $1,659.59 | $6,309.57 | $9,120.11 |
Premera BCBS Setting Professional Modifier None Typical Low $6,309.57 Median $6,309.57 Typical High $6,309.57 | Professional | None | $6,309.57 | $6,309.57 | $6,309.57 |
Providence Setting Facility Modifier None Typical Low $8,317.64 Median $251,188.64 Typical High $346,736.85 | Facility | None | $8,317.64 | $251,188.64 | $346,736.85 |
Providence Setting Professional Modifier None Typical Low $60.26 Median $2,187.76 Typical High $4,677.35 | Professional | None | $60.26 | $2,187.76 | $4,677.35 |
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 $1,479.11 Median $4,168.69 Typical High $9,549.93 | Professional | None | $1,479.11 | $4,168.69 | $9,549.93 |
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 $758.58 Median $4,073.80 Typical High $4,073.80 | Professional | 52 · Reduced service | $758.58 | $4,073.80 | $4,073.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $1,659.59 Typical High $1,659.59 | Professional | 53 · Discontinued | $302.00 | $1,659.59 | $1,659.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $6,165.95 Typical High $6,165.95 | Professional | 54 · Surgery only | $1,148.15 | $6,165.95 | $6,165.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $1,230.27 Typical High $1,230.27 | Professional | 55 · Aftercare only | $229.09 | $1,230.27 | $1,230.27 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $812.83 Typical High $812.83 | Professional | 56 · Pre-op care only | $151.36 | $812.83 | $812.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $5,754.40 Typical High $5,754.40 | Professional | 78 · Unplanned return to OR | $1,071.52 | $5,754.40 | $5,754.40 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $831.76 Median $4,073.80 Typical High $4,073.80 | Professional | 52 · Reduced service | $831.76 | $4,073.80 | $4,073.80 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $1,659.59 Typical High $1,659.59 | Professional | 53 · Discontinued | $338.84 | $1,659.59 | $1,659.59 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $6,165.95 Typical High $6,165.95 | Professional | 54 · Surgery only | $1,258.93 | $6,165.95 | $6,165.95 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $1,230.27 Typical High $1,230.27 | Professional | 55 · Aftercare only | $251.19 | $1,230.27 | $1,230.27 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $165.96 Median $812.83 Typical High $812.83 | Professional | 56 · Pre-op care only | $165.96 | $812.83 | $812.83 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $5,754.40 Typical High $5,754.40 | Professional | 78 · Unplanned return to OR | $1,174.90 | $5,754.40 | $5,754.40 |
Where Alaska sits
The same service costs 8.2 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 $17,891MD $2,184
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.