How much rates vary
Facilitymedian $1,514 · 10th to 90th $562 to $6,166Professionalmedian $832 · 10th to 90th $676 to $1,413
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 $724.44 Median $4,897.79 Typical High $8,511.38 | Facility | None | $724.44 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $676.08 Median $831.76 Typical High $851.14 | Professional | None | $676.08 | $831.76 | $851.14 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $478.63 Median $575.44 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $478.63 | $575.44 | $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 $776.25 Median $776.25 Typical High $1,479.11 | Professional | None | $776.25 | $776.25 | $1,479.11 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $645.65 Median $1,023.29 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $645.65 | $1,023.29 | $1,318.26 |
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 $724.44 Median $831.76 Typical High $1,479.11 | Professional | None | $724.44 | $831.76 | $1,479.11 |
Emblem Health Setting Professional Modifier None Typical Low $1,096.48 Median $1,096.48 Typical High $1,174.90 | Professional | None | $1,096.48 | $1,096.48 | $1,174.90 |
Geisinger Setting Professional Modifier None Typical Low $707.95 Median $933.25 Typical High $1,513.56 | Professional | None | $707.95 | $933.25 | $1,513.56 |
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 $676.08 Median $831.76 Typical High $831.76 | Professional | None | $676.08 | $831.76 | $831.76 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $478.63 Median $575.44 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $478.63 | $575.44 | $575.44 |
Oscar Health Setting Professional Modifier None Typical Low $870.96 Median $977.24 Typical High $1,698.24 | Professional | None | $870.96 | $977.24 | $1,698.24 |
UPMC Health Plan Setting Facility Modifier None Typical Low $741.31 Median $870.96 Typical High $870.96 | Facility | None | $741.31 | $870.96 | $870.96 |
UPMC Health Plan Setting Professional Modifier None Typical Low $741.31 Median $870.96 Typical High $870.96 | Professional | None | $741.31 | $870.96 | $870.96 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,862.09 Typical High $3,890.45 | Facility | None | $1,148.15 | $1,862.09 | $3,890.45 |
United Setting Professional Modifier None Typical Low $724.44 Median $912.01 Typical High $1,548.82 | Professional | None | $724.44 | $912.01 | $1,548.82 |
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 $338.84 Median $407.38 Typical High $407.38 | Professional | 52 · Reduced service | $338.84 | $407.38 | $407.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $138.04 Median $165.96 Typical High $165.96 | Professional | 53 · Discontinued | $138.04 | $165.96 | $165.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $512.86 Median $616.60 Typical High $616.60 | Professional | 54 · Surgery only | $512.86 | $616.60 | $616.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $102.33 Median $123.03 Typical High $123.03 | Professional | 55 · Aftercare only | $102.33 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $67.61 Median $83.18 Typical High $83.18 | Professional | 56 · Pre-op care only | $67.61 | $83.18 | $83.18 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $338.84 Median $407.38 Typical High $407.38 | Professional | 52 · Reduced service | $338.84 | $407.38 | $407.38 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $138.04 Median $165.96 Typical High $165.96 | Professional | 53 · Discontinued | $138.04 | $165.96 | $165.96 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $512.86 Median $616.60 Typical High $616.60 | Professional | 54 · Surgery only | $512.86 | $616.60 | $616.60 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $102.33 Median $123.03 Typical High $123.03 | Professional | 55 · Aftercare only | $102.33 | $123.03 | $123.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $67.61 Median $83.18 Typical High $83.18 | Professional | 56 · Pre-op care only | $67.61 | $83.18 | $83.18 |
Where Pennsylvania sits
The same service costs 7.8 times more in Maine than in Massachusetts. 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 $16,585MA $2,122
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.