How much rates vary
Facilitymedian $776 · 10th to 90th $240 to $6,310Professionalmedian $776 · 10th to 90th $676 to $1,380
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 $758.58 Median $4,897.79 Typical High $8,511.38 | Facility | None | $758.58 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $724.44 Median $794.33 Typical High $812.83 | Professional | None | $724.44 | $794.33 | $812.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $501.19 Median $562.34 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $501.19 | $562.34 | $575.44 |
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 $954.99 Median $1,412.54 Typical High $1,412.54 | Professional | None | $954.99 | $1,412.54 | $1,412.54 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $1,000.00 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $630.96 | $1,000.00 | $1,202.26 |
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 $676.08 Median $741.31 Typical High $1,513.56 | Professional | None | $676.08 | $741.31 | $1,513.56 |
Emblem Health Setting Professional Modifier None Typical Low $870.96 Median $1,174.90 Typical High $1,659.59 | Professional | None | $870.96 | $1,174.90 | $1,659.59 |
Geisinger Setting Professional Modifier None Typical Low $691.83 Median $794.33 Typical High $1,380.38 | Professional | None | $691.83 | $794.33 | $1,380.38 |
Martin's Point Setting Facility Modifier None Typical Low $812.83 Median $3,801.89 Typical High $8,709.64 | Facility | None | $812.83 | $3,801.89 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $724.44 Median $794.33 Typical High $812.83 | Professional | None | $724.44 | $794.33 | $812.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $501.19 Median $562.34 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $501.19 | $562.34 | $575.44 |
Oscar Health Setting Professional Modifier None Typical Low $891.25 Median $933.25 Typical High $1,445.44 | Professional | None | $891.25 | $933.25 | $1,445.44 |
UPMC Health Plan Setting Facility Modifier None Typical Low $758.58 Median $794.33 Typical High $794.33 | Facility | None | $758.58 | $794.33 | $794.33 |
UPMC Health Plan Setting Professional Modifier None Typical Low $758.58 Median $776.25 Typical High $794.33 | Professional | None | $758.58 | $776.25 | $794.33 |
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 $676.08 Median $794.33 Typical High $1,258.93 | Professional | None | $676.08 | $794.33 | $1,258.93 |
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 $363.08 Median $398.11 Typical High $407.38 | Professional | 52 · Reduced service | $363.08 | $398.11 | $407.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $158.49 Typical High $165.96 | Professional | 53 · Discontinued | $144.54 | $158.49 | $165.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $537.03 Median $602.56 Typical High $616.60 | Professional | 54 · Surgery only | $537.03 | $602.56 | $616.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $107.15 Median $120.23 Typical High $123.03 | Professional | 55 · Aftercare only | $107.15 | $120.23 | $123.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $79.43 Typical High $81.28 | Professional | 56 · Pre-op care only | $72.44 | $79.43 | $81.28 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $363.08 Median $398.11 Typical High $407.38 | Professional | 52 · Reduced service | $363.08 | $398.11 | $407.38 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $158.49 Typical High $165.96 | Professional | 53 · Discontinued | $144.54 | $158.49 | $165.96 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $537.03 Median $602.56 Typical High $616.60 | Professional | 54 · Surgery only | $537.03 | $602.56 | $616.60 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $107.15 Median $120.23 Typical High $123.03 | Professional | 55 · Aftercare only | $107.15 | $120.23 | $123.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $79.43 Typical High $81.28 | Professional | 56 · Pre-op care only | $72.44 | $79.43 | $81.28 |
Where Pennsylvania sits
The same service costs 12.3 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 $16,849MD $1,375
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.