How much rates vary
Facilitymedian $794 · 10th to 90th $251 to $6,310Professionalmedian $1,349 · 10th to 90th $1,122 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 $1,122.02 Median $1,348.96 Typical High $1,348.96 | Professional | None | $1,122.02 | $1,348.96 | $1,348.96 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $776.25 | $933.25 | $933.25 |
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 $1,949.84 Median $1,949.84 Typical High $56,234.13 | Professional | None | $1,949.84 | $1,949.84 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,659.59 Typical High $2,041.74 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,659.59 | $2,041.74 |
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 $1,174.90 Median $1,318.26 Typical High $2,398.83 | Professional | None | $1,174.90 | $1,318.26 | $2,398.83 |
Emblem Health Setting Professional Modifier None Typical Low $1,778.28 Median $1,778.28 Typical High $1,905.46 | Professional | None | $1,778.28 | $1,778.28 | $1,905.46 |
Geisinger Setting Professional Modifier None Typical Low $1,148.15 Median $1,548.82 Typical High $2,454.71 | Professional | None | $1,148.15 | $1,548.82 | $2,454.71 |
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 $1,122.02 Median $1,318.26 Typical High $1,348.96 | Professional | None | $1,122.02 | $1,318.26 | $1,348.96 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $776.25 | $933.25 | $933.25 |
Oscar Health Setting Professional Modifier None Typical Low $1,412.54 Median $1,513.56 Typical High $2,754.23 | Professional | None | $1,412.54 | $1,513.56 | $2,754.23 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,202.26 Median $1,380.38 Typical High $1,380.38 | Facility | None | $1,202.26 | $1,380.38 | $1,380.38 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,202.26 Median $1,380.38 Typical High $1,380.38 | Professional | None | $1,202.26 | $1,380.38 | $1,380.38 |
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 $1,174.90 Median $1,479.11 Typical High $2,511.89 | Professional | None | $1,174.90 | $1,479.11 | $2,511.89 |
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 $549.54 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $549.54 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $269.15 Typical High $269.15 | Professional | 53 · Discontinued | $223.87 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $831.76 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $165.96 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $134.90 Typical High $134.90 | Professional | 56 · Pre-op care only | $112.20 | $134.90 | $134.90 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $549.54 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $549.54 | $660.69 | $660.69 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $269.15 Typical High $269.15 | Professional | 53 · Discontinued | $223.87 | $269.15 | $269.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $831.76 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $165.96 | $199.53 | $199.53 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $134.90 Typical High $134.90 | Professional | 56 · Pre-op care only | $112.20 | $134.90 | $134.90 |
Where Pennsylvania sits
The same service costs 9.0 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 $17,266MD $1,911
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.