How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $871 · 10th to 90th $776 to $1,202
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 $831.76 Median $4,897.79 Typical High $8,511.38 | Facility | None | $831.76 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $831.76 Median $912.01 Typical High $933.25 | Professional | None | $831.76 | $912.01 | $933.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $575.44 Median $630.96 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $575.44 | $630.96 | $660.69 |
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 $1,288.25 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,288.25 | $1,288.25 | $1,288.25 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $1,202.26 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $724.44 | $1,202.26 | $1,445.44 |
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 $776.25 Median $870.96 Typical High $1,737.80 | Professional | None | $776.25 | $870.96 | $1,737.80 |
Emblem Health Setting Professional Modifier None Typical Low $1,000.00 Median $1,348.96 Typical High $1,905.46 | Professional | None | $1,000.00 | $1,348.96 | $1,905.46 |
Geisinger Setting Professional Modifier None Typical Low $758.58 Median $891.25 Typical High $1,584.89 | Professional | None | $758.58 | $891.25 | $1,584.89 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $3,801.89 Typical High $8,709.64 | Facility | None | $831.76 | $3,801.89 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $831.76 Median $891.25 Typical High $933.25 | Professional | None | $831.76 | $891.25 | $933.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $575.44 Median $630.96 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $575.44 | $630.96 | $660.69 |
Oscar Health Setting Professional Modifier None Typical Low $794.33 Median $831.76 Typical High $1,659.59 | Professional | None | $794.33 | $831.76 | $1,659.59 |
UPMC Health Plan Setting Facility Modifier None Typical Low $794.33 Median $794.33 Typical High $870.96 | Facility | None | $794.33 | $794.33 | $870.96 |
UPMC Health Plan Setting Professional Modifier None Typical Low $794.33 Median $870.96 Typical High $870.96 | Professional | None | $794.33 | $870.96 | $870.96 |
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 $776.25 Median $912.01 Typical High $1,445.44 | Professional | None | $776.25 | $912.01 | $1,445.44 |
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 $407.38 Median $457.09 Typical High $467.74 | Professional | 52 · Reduced service | $407.38 | $457.09 | $467.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $165.96 Median $181.97 Typical High $186.21 | Professional | 53 · Discontinued | $165.96 | $181.97 | $186.21 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $616.60 Median $676.08 Typical High $707.95 | Professional | 54 · Surgery only | $616.60 | $676.08 | $707.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $123.03 Median $138.04 Typical High $141.25 | Professional | 55 · Aftercare only | $123.03 | $138.04 | $141.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $91.20 Typical High $93.33 | Professional | 56 · Pre-op care only | $83.18 | $91.20 | $93.33 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $407.38 Median $457.09 Typical High $467.74 | Professional | 52 · Reduced service | $407.38 | $457.09 | $467.74 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $165.96 Median $181.97 Typical High $186.21 | Professional | 53 · Discontinued | $165.96 | $181.97 | $186.21 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $616.60 Median $676.08 Typical High $707.95 | Professional | 54 · Surgery only | $616.60 | $676.08 | $707.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $123.03 Median $138.04 Typical High $141.25 | Professional | 55 · Aftercare only | $123.03 | $138.04 | $141.25 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $91.20 Typical High $93.33 | Professional | 56 · Pre-op care only | $83.18 | $91.20 | $93.33 |
Where Pennsylvania sits
The same service costs 11.4 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 $16,997MD $1,496
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.