How much rates vary
Facilitymedian $10,471 · 10th to 90th $1,000 to $251,189Professionalmedian $6,918 · 10th to 90th $1,995 to $10,471
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 $1,949.84 Median $10,471.29 Typical High $10,471.29 | Professional | None | $1,949.84 | $10,471.29 | $10,471.29 |
Cigna Setting Professional Modifier None Typical Low $1,737.80 Median $2,754.23 Typical High $5,888.44 | Professional | None | $1,737.80 | $2,754.23 | $5,888.44 |
Moda Health Setting Facility Modifier None Typical Low $3,090.30 Median $10,471.29 Typical High $15,135.61 | Facility | None | $3,090.30 | $10,471.29 | $15,135.61 |
Moda Health Setting Professional Modifier None Typical Low $2,137.96 Median $8,128.31 Typical High $11,748.98 | Professional | None | $2,137.96 | $8,128.31 | $11,748.98 |
Premera BCBS Setting Professional Modifier None Typical Low $8,128.31 Median $8,128.31 Typical High $8,128.31 | Professional | None | $8,128.31 | $8,128.31 | $8,128.31 |
Providence Setting Facility Modifier None Typical Low $10,471.29 Median $251,188.64 Typical High $346,736.85 | Facility | None | $10,471.29 | $251,188.64 | $346,736.85 |
Providence Setting Professional Modifier None Typical Low $60.26 Median $2,818.38 Typical High $5,888.44 | Professional | None | $60.26 | $2,818.38 | $5,888.44 |
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 $1,862.09 Median $5,370.32 Typical High $12,302.69 | Professional | None | $1,862.09 | $5,370.32 | $12,302.69 |
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 $977.24 Median $5,248.07 Typical High $5,248.07 | Professional | 52 · Reduced service | $977.24 | $5,248.07 | $5,248.07 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $2,089.30 Typical High $2,089.30 | Professional | 53 · Discontinued | $389.05 | $2,089.30 | $2,089.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,479.11 Median $7,943.28 Typical High $7,943.28 | Professional | 54 · Surgery only | $1,479.11 | $7,943.28 | $7,943.28 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $295.12 Median $1,584.89 Typical High $1,584.89 | Professional | 55 · Aftercare only | $295.12 | $1,584.89 | $1,584.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $1,047.13 Typical High $1,047.13 | Professional | 56 · Pre-op care only | $194.98 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,380.38 Median $7,413.10 Typical High $7,413.10 | Professional | 78 · Unplanned return to OR | $1,380.38 | $7,413.10 | $7,413.10 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1,071.52 Median $5,248.07 Typical High $5,248.07 | Professional | 52 · Reduced service | $1,071.52 | $5,248.07 | $5,248.07 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $426.58 Median $2,089.30 Typical High $2,089.30 | Professional | 53 · Discontinued | $426.58 | $2,089.30 | $2,089.30 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $1,621.81 Median $7,943.28 Typical High $7,943.28 | Professional | 54 · Surgery only | $1,621.81 | $7,943.28 | $7,943.28 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $323.59 Median $1,584.89 Typical High $1,584.89 | Professional | 55 · Aftercare only | $323.59 | $1,584.89 | $1,584.89 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $213.80 Median $1,047.13 Typical High $1,047.13 | Professional | 56 · Pre-op care only | $213.80 | $1,047.13 | $1,047.13 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,513.56 Median $7,413.10 Typical High $7,413.10 | Professional | 78 · Unplanned return to OR | $1,513.56 | $7,413.10 | $7,413.10 |
Where Alaska sits
The same service costs 6.9 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 $18,419MD $2,652
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.