How much rates vary
Facilitymedian $794 · 10th to 90th $302 to $6,166Professionalmedian $1,585 · 10th to 90th $1,380 to $2,239
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 $1,479.11 Median $1,621.81 Typical High $1,819.70 | Professional | None | $1,479.11 | $1,621.81 | $1,819.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,148.15 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,148.15 | $1,174.90 |
Ambetter Setting Professional Modifier None Typical Low $1,445.44 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,445.44 | $1,445.44 | $1,445.44 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $22,387.21 Typical High $28,183.83 | Facility | None | $3,981.07 | $22,387.21 | $28,183.83 |
Capital Blue Cross Setting Professional Modifier None Typical Low $2,344.23 Median $2,344.23 Typical High $2,344.23 | Professional | None | $2,344.23 | $2,344.23 | $2,344.23 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,288.25 Median $2,187.76 Typical High $2,570.40 | Professional | 78 · Unplanned return to OR | $1,288.25 | $2,187.76 | $2,570.40 |
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 $1,380.38 Median $1,548.82 Typical High $3,162.28 | Professional | None | $1,380.38 | $1,548.82 | $3,162.28 |
Emblem Health Setting Professional Modifier None Typical Low $1,778.28 Median $2,398.83 Typical High $3,311.31 | Professional | None | $1,778.28 | $2,398.83 | $3,311.31 |
Geisinger Setting Professional Modifier None Typical Low $1,380.38 Median $1,584.89 Typical High $2,884.03 | Professional | None | $1,380.38 | $1,584.89 | $2,884.03 |
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 $1,479.11 Median $1,621.81 Typical High $1,698.24 | Professional | None | $1,479.11 | $1,621.81 | $1,698.24 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,148.15 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,148.15 | $1,174.90 |
Oscar Health Setting Professional Modifier None Typical Low $1,174.90 Median $1,230.27 Typical High $3,019.95 | Professional | None | $1,174.90 | $1,230.27 | $3,019.95 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,479.11 Median $2,187.76 Typical High $3,715.35 | Facility | None | $1,479.11 | $2,187.76 | $3,715.35 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,479.11 Median $1,548.82 Typical High $1,584.89 | Professional | None | $1,479.11 | $1,548.82 | $1,584.89 |
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 $1,380.38 Median $1,621.81 Typical High $2,570.40 | Professional | None | $1,380.38 | $1,621.81 | $2,570.40 |
11 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 $741.31 Median $831.76 Typical High $851.14 | Professional | 52 · Reduced service | $741.31 | $831.76 | $851.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $331.13 Typical High $338.84 | Professional | 53 · Discontinued | $295.12 | $331.13 | $338.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $1,230.27 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,122.02 | $1,230.27 | $1,258.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $245.47 Typical High $257.04 | Professional | 55 · Aftercare only | $223.87 | $245.47 | $257.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $165.96 Typical High $169.82 | Professional | 56 · Pre-op care only | $147.91 | $165.96 | $169.82 |
Highmark BCBS Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $234.42 Median $234.42 Typical High $234.42 | Professional | 82 · Assistant surgeon, no resident | $234.42 | $234.42 | $234.42 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $741.31 Median $831.76 Typical High $851.14 | Professional | 52 · Reduced service | $741.31 | $831.76 | $851.14 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $331.13 Typical High $338.84 | Professional | 53 · Discontinued | $295.12 | $331.13 | $338.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $1,230.27 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,122.02 | $1,230.27 | $1,258.93 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $245.47 Typical High $257.04 | Professional | 55 · Aftercare only | $223.87 | $245.47 | $257.04 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $165.96 Typical High $169.82 | Professional | 56 · Pre-op care only | $147.91 | $165.96 | $169.82 |
Where Pennsylvania 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.