How much rates vary
Facilitymedian $1,122 · 10th to 90th $550 to $6,026Professionalmedian $646 · 10th to 90th $562 to $1,122
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 $588.84 Median $4,897.79 Typical High $8,511.38 | Facility | None | $588.84 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $537.03 Median $588.84 Typical High $645.65 | Professional | None | $537.03 | $588.84 | $645.65 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $371.54 Median $416.87 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $371.54 | $416.87 | $436.52 |
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 $1,047.13 Median $1,047.13 Typical High $56,234.13 | Professional | None | $1,047.13 | $1,047.13 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $489.78 Median $776.25 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $489.78 | $776.25 | $954.99 |
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 $588.84 Median $707.95 Typical High $1,288.25 | Professional | None | $588.84 | $707.95 | $1,288.25 |
Emblem Health Setting Professional Modifier None Typical Low $1,000.00 Median $1,000.00 Typical High $1,071.52 | Professional | None | $1,000.00 | $1,000.00 | $1,071.52 |
Geisinger Setting Professional Modifier None Typical Low $602.56 Median $812.83 Typical High $1,348.96 | Professional | None | $602.56 | $812.83 | $1,348.96 |
Martin's Point Setting Facility Modifier None Typical Low $588.84 Median $3,801.89 Typical High $8,709.64 | Facility | None | $588.84 | $3,801.89 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $537.03 Median $588.84 Typical High $630.96 | Professional | None | $537.03 | $588.84 | $630.96 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $371.54 Median $416.87 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $371.54 | $416.87 | $436.52 |
Oscar Health Setting Professional Modifier None Typical Low $758.58 Median $794.33 Typical High $1,258.93 | Professional | None | $758.58 | $794.33 | $1,258.93 |
UPMC Health Plan Setting Facility Modifier None Typical Low $645.65 Median $691.83 Typical High $691.83 | Facility | None | $645.65 | $691.83 | $691.83 |
UPMC Health Plan Setting Professional Modifier None Typical Low $645.65 Median $691.83 Typical High $691.83 | Professional | None | $645.65 | $691.83 | $691.83 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,288.25 Typical High $3,162.28 | Facility | None | $812.83 | $1,288.25 | $3,162.28 |
United Setting Professional Modifier None Typical Low $602.56 Median $776.25 Typical High $1,288.25 | Professional | None | $602.56 | $776.25 | $1,288.25 |
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 $269.15 Median $295.12 Typical High $316.23 | Professional | 52 · Reduced service | $269.15 | $295.12 | $316.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $107.15 Median $117.49 Typical High $125.89 | Professional | 53 · Discontinued | $107.15 | $117.49 | $125.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $398.11 Median $446.68 Typical High $467.74 | Professional | 54 · Surgery only | $398.11 | $446.68 | $467.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $79.43 Median $89.13 Typical High $93.33 | Professional | 55 · Aftercare only | $79.43 | $89.13 | $93.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $53.70 Median $58.88 Typical High $63.10 | Professional | 56 · Pre-op care only | $53.70 | $58.88 | $63.10 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $269.15 Median $295.12 Typical High $316.23 | Professional | 52 · Reduced service | $269.15 | $295.12 | $316.23 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $107.15 Median $117.49 Typical High $125.89 | Professional | 53 · Discontinued | $107.15 | $117.49 | $125.89 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $398.11 Median $446.68 Typical High $467.74 | Professional | 54 · Surgery only | $398.11 | $446.68 | $467.74 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $79.43 Median $89.13 Typical High $93.33 | Professional | 55 · Aftercare only | $79.43 | $89.13 | $93.33 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $53.70 Median $58.88 Typical High $63.10 | Professional | 56 · Pre-op care only | $53.70 | $58.88 | $63.10 |
Where Pennsylvania sits
The same service costs 14.1 times more in Maine than in Texas. 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 $23,299TX $1,649
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.