How much rates vary
Facilitymedian $891 · 10th to 90th $316 to $7,943Professionalmedian $1,778 · 10th to 90th $1,445 to $3,236
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 $1,047.13 Median $5,495.41 Typical High $8,709.64 | Facility | None | $1,047.13 | $5,495.41 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $1,445.44 Median $1,737.80 Typical High $1,778.28 | Professional | None | $1,445.44 | $1,737.80 | $1,778.28 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,202.26 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,202.26 | $1,230.27 |
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 $1,621.81 Median $2,691.53 Typical High $3,467.37 | Professional | None | $1,621.81 | $2,691.53 | $3,467.37 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $2,238.72 Typical High $2,884.03 | Professional | 78 · Unplanned return to OR | $1,348.96 | $2,238.72 | $2,884.03 |
Cigna Setting Facility Modifier None Typical Low $380.19 Median $660.69 Typical High $2,290.87 | Facility | None | $380.19 | $660.69 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,445.44 Median $1,698.24 Typical High $3,090.30 | Professional | None | $1,445.44 | $1,698.24 | $3,090.30 |
Emblem Health Setting Professional Modifier None Typical Low $2,454.71 Median $2,454.71 Typical High $2,691.53 | Professional | None | $2,454.71 | $2,454.71 | $2,691.53 |
Geisinger Setting Professional Modifier None Typical Low $1,479.11 Median $1,995.26 Typical High $3,311.31 | Professional | None | $1,479.11 | $1,995.26 | $3,311.31 |
Martin's Point Setting Facility Modifier None Typical Low $1,148.15 Median $5,248.07 Typical High $8,709.64 | Facility | None | $1,148.15 | $5,248.07 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,445.44 Median $1,737.80 Typical High $1,778.28 | Professional | None | $1,445.44 | $1,737.80 | $1,778.28 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,202.26 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,202.26 | $1,230.27 |
Oscar Health Setting Professional Modifier None Typical Low $1,698.24 Median $1,819.70 Typical High $3,162.28 | Professional | None | $1,698.24 | $1,819.70 | $3,162.28 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $1,584.89 | Facility | None | $1,584.89 | $1,584.89 | $1,584.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $1,621.81 | Professional | None | $1,584.89 | $1,584.89 | $1,621.81 |
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 $1,479.11 Median $1,905.46 Typical High $3,235.94 | Professional | None | $1,479.11 | $1,905.46 | $3,235.94 |
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 $724.44 Median $870.96 Typical High $891.25 | Professional | 52 · Reduced service | $724.44 | $870.96 | $891.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $288.40 Median $346.74 Typical High $354.81 | Professional | 53 · Discontinued | $288.40 | $346.74 | $354.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,288.25 Typical High $1,318.26 | Professional | 54 · Surgery only | $1,071.52 | $1,288.25 | $1,318.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $218.78 Median $257.04 Typical High $263.03 | Professional | 55 · Aftercare only | $218.78 | $257.04 | $263.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $144.54 Median $173.78 Typical High $177.83 | Professional | 56 · Pre-op care only | $144.54 | $173.78 | $177.83 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $2,454.71 Median $4,073.80 Typical High $5,248.07 | Professional | 50 · Both sides | $2,454.71 | $4,073.80 | $5,248.07 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $724.44 Median $870.96 Typical High $891.25 | Professional | 52 · Reduced service | $724.44 | $870.96 | $891.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $288.40 Median $346.74 Typical High $354.81 | Professional | 53 · Discontinued | $288.40 | $346.74 | $354.81 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,288.25 Typical High $1,318.26 | Professional | 54 · Surgery only | $1,071.52 | $1,288.25 | $1,318.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $218.78 Median $257.04 Typical High $263.03 | Professional | 55 · Aftercare only | $218.78 | $257.04 | $263.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $144.54 Median $173.78 Typical High $177.83 | Professional | 56 · Pre-op care only | $144.54 | $173.78 | $177.83 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $1,548.82 Median $1,548.82 Typical High $1,548.82 | Professional | 62 · Two surgeons | $1,548.82 | $1,548.82 | $1,548.82 |
Where Pennsylvania sits
The same service costs 11.9 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 $28,541MD $2,395
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.