How much rates vary
Facilitymedian $8,511 · 10th to 90th $1,000 to $251,189Professionalmedian $5,012 · 10th to 90th $1,549 to $8,511
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 $8,511.38 Median $12,022.64 Typical High $16,595.87 | Facility | None | $8,511.38 | $12,022.64 | $16,595.87 |
Aetna Setting Professional Modifier None Typical Low $1,513.56 Median $7,762.47 Typical High $8,511.38 | Professional | None | $1,513.56 | $7,762.47 | $8,511.38 |
Cigna Setting Professional Modifier None Typical Low $1,348.96 Median $2,187.76 Typical High $4,786.30 | Professional | None | $1,348.96 | $2,187.76 | $4,786.30 |
Moda Health Setting Facility Modifier None Typical Low $2,511.89 Median $8,511.38 Typical High $12,022.64 | Facility | None | $2,511.89 | $8,511.38 | $12,022.64 |
Moda Health Setting Professional Modifier None Typical Low $1,548.82 Median $5,128.61 Typical High $9,332.54 | Professional | None | $1,548.82 | $5,128.61 | $9,332.54 |
Premera BCBS Setting Professional Modifier None Typical Low $6,456.54 Median $6,456.54 Typical High $6,456.54 | Professional | None | $6,456.54 | $6,456.54 | $6,456.54 |
Providence Setting Facility Modifier None Typical Low $8,511.38 Median $251,188.64 Typical High $346,736.85 | Facility | None | $8,511.38 | $251,188.64 | $346,736.85 |
Providence Setting Professional Modifier None Typical Low $60.26 Median $2,238.72 Typical High $4,786.30 | Professional | None | $60.26 | $2,238.72 | $4,786.30 |
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 $4,265.80 Typical High $9,772.37 | Professional | None | $1,479.11 | $4,265.80 | $9,772.37 |
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 $776.25 Median $4,168.69 Typical High $4,168.69 | Professional | 52 · Reduced service | $776.25 | $4,168.69 | $4,168.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $1,698.24 Typical High $1,698.24 | Professional | 53 · Discontinued | $309.03 | $1,698.24 | $1,698.24 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $6,309.57 Typical High $6,309.57 | Professional | 54 · Surgery only | $1,174.90 | $6,309.57 | $6,309.57 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $1,258.93 Typical High $1,258.93 | Professional | 55 · Aftercare only | $234.42 | $1,258.93 | $1,258.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $851.14 Typical High $851.14 | Professional | 56 · Pre-op care only | $154.88 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $5,888.44 Typical High $5,888.44 | Professional | 78 · Unplanned return to OR | $1,096.48 | $5,888.44 | $5,888.44 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $851.14 Median $4,168.69 Typical High $4,168.69 | Professional | 52 · Reduced service | $851.14 | $4,168.69 | $4,168.69 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $1,698.24 Typical High $1,698.24 | Professional | 53 · Discontinued | $338.84 | $1,698.24 | $1,698.24 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $1,288.25 Median $6,309.57 Typical High $6,309.57 | Professional | 54 · Surgery only | $1,288.25 | $6,309.57 | $6,309.57 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $1,258.93 Typical High $1,258.93 | Professional | 55 · Aftercare only | $257.04 | $1,258.93 | $1,258.93 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $851.14 Typical High $851.14 | Professional | 56 · Pre-op care only | $169.82 | $851.14 | $851.14 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $5,888.44 Typical High $5,888.44 | Professional | 78 · Unplanned return to OR | $1,202.26 | $5,888.44 | $5,888.44 |
Where Alaska sits
The same service costs 8.1 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 $2,222
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.