How much rates vary
Facilitymedian $1,288 · 10th to 90th $575 to $6,026Professionalmedian $1,175 · 10th to 90th $977 to $2,138
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 $3,801.89 Typical High $8,511.38 | Facility | None | $831.76 | $3,801.89 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $977.24 Median $1,174.90 Typical High $1,288.25 | Professional | None | $977.24 | $1,174.90 | $1,288.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $831.76 Typical High $831.76 | Professional | 78 · Unplanned return to OR | $691.83 | $831.76 | $831.76 |
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 $1,122.02 Median $1,778.28 Typical High $2,187.76 | Professional | None | $1,122.02 | $1,778.28 | $2,187.76 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $1,479.11 Typical High $1,819.70 | Professional | 78 · Unplanned return to OR | $912.01 | $1,479.11 | $1,819.70 |
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 $1,047.13 Median $1,174.90 Typical High $2,137.96 | Professional | None | $1,047.13 | $1,174.90 | $2,137.96 |
Emblem Health Setting Professional Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $1,698.24 | Professional | None | $1,584.89 | $1,584.89 | $1,698.24 |
Geisinger Setting Professional Modifier None Typical Low $1,023.29 Median $1,348.96 Typical High $2,187.76 | Professional | None | $1,023.29 | $1,348.96 | $2,187.76 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,890.45 Median $3,890.45 Typical High $3,890.45 | Facility | None | $3,890.45 | $3,890.45 | $3,890.45 |
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 $977.24 Median $1,174.90 Typical High $1,288.25 | Professional | None | $977.24 | $1,174.90 | $1,288.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $831.76 Typical High $831.76 | Professional | 78 · Unplanned return to OR | $691.83 | $831.76 | $831.76 |
Oscar Health Setting Professional Modifier None Typical Low $1,258.93 Median $1,412.54 Typical High $2,398.83 | Professional | None | $1,258.93 | $1,412.54 | $2,398.83 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,071.52 Median $2,187.76 Typical High $3,548.13 | Facility | None | $1,071.52 | $2,187.76 | $3,548.13 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,071.52 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,071.52 | $1,288.25 | $1,288.25 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,288.25 Typical High $3,311.31 | Facility | None | $812.83 | $1,288.25 | $3,311.31 |
United Setting Professional Modifier None Typical Low $1,047.13 Median $1,288.25 Typical High $2,238.72 | Professional | None | $1,047.13 | $1,288.25 | $2,238.72 |
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 $489.78 Median $588.84 Typical High $588.84 | Professional | 52 · Reduced service | $489.78 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $194.98 Median $239.88 Typical High $239.88 | Professional | 53 · Discontinued | $194.98 | $239.88 | $239.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $891.25 Typical High $891.25 | Professional | 54 · Surgery only | $741.31 | $891.25 | $891.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $177.83 Typical High $177.83 | Professional | 55 · Aftercare only | $147.91 | $177.83 | $177.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $97.72 Median $117.49 Typical High $117.49 | Professional | 56 · Pre-op care only | $97.72 | $117.49 | $117.49 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,659.59 Median $2,630.27 Typical High $3,311.31 | Professional | 50 · Both sides | $1,659.59 | $2,630.27 | $3,311.31 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $489.78 Median $588.84 Typical High $588.84 | Professional | 52 · Reduced service | $489.78 | $588.84 | $588.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $194.98 Median $234.42 Typical High $239.88 | Professional | 53 · Discontinued | $194.98 | $234.42 | $239.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $891.25 Typical High $891.25 | Professional | 54 · Surgery only | $741.31 | $891.25 | $891.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $177.83 Typical High $177.83 | Professional | 55 · Aftercare only | $147.91 | $177.83 | $177.83 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $97.72 Median $117.49 Typical High $117.49 | Professional | 56 · Pre-op care only | $97.72 | $117.49 | $117.49 |
Where Pennsylvania sits
The same service costs 7.4 times more in Maine than in Delaware. 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 $17,002DE $2,297
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.