How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,148 · 10th to 90th $1,000 to $1,995
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 $4,897.79 Typical High $8,511.38 | Facility | None | $831.76 | $4,897.79 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,000.00 Median $1,096.48 Typical High $1,148.15 | Professional | None | $1,000.00 | $1,096.48 | $1,148.15 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $707.95 Median $776.25 Typical High $776.25 | Professional | 78 · Unplanned return to OR | $707.95 | $776.25 | $776.25 |
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 $1,584.89 Median $1,778.28 Typical High $1,995.26 | Professional | None | $1,584.89 | $1,778.28 | $1,995.26 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $1,479.11 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $912.01 | $1,479.11 | $1,862.09 |
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 $1,071.52 Median $1,202.26 Typical High $2,290.87 | Professional | None | $1,071.52 | $1,202.26 | $2,290.87 |
Emblem Health Setting Professional Modifier None Typical Low $1,698.24 Median $1,698.24 Typical High $1,905.46 | Professional | None | $1,698.24 | $1,698.24 | $1,905.46 |
Geisinger Setting Professional Modifier None Typical Low $1,096.48 Median $1,479.11 Typical High $2,344.23 | Professional | None | $1,096.48 | $1,479.11 | $2,344.23 |
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 $1,000.00 Median $1,096.48 Typical High $1,202.26 | Professional | None | $1,000.00 | $1,096.48 | $1,202.26 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $707.95 Median $776.25 Typical High $776.25 | Professional | 78 · Unplanned return to OR | $707.95 | $776.25 | $776.25 |
Oscar Health Setting Professional Modifier None Typical Low $12.02 Median $1,584.89 Typical High $2,344.23 | Professional | None | $12.02 | $1,584.89 | $2,344.23 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,096.48 Median $1,348.96 Typical High $1,348.96 | Facility | None | $1,096.48 | $1,348.96 | $1,348.96 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,096.48 Median $1,348.96 Typical High $1,348.96 | Professional | None | $1,096.48 | $1,348.96 | $1,348.96 |
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 $1,096.48 Median $1,288.25 Typical High $2,238.72 | Professional | None | $1,096.48 | $1,288.25 | $2,238.72 |
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 $501.19 Median $549.54 Typical High $562.34 | Professional | 52 · Reduced service | $501.19 | $549.54 | $562.34 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $223.87 Typical High $223.87 | Professional | 53 · Discontinued | $199.53 | $223.87 | $223.87 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $758.58 Median $831.76 Typical High $831.76 | Professional | 54 · Surgery only | $758.58 | $831.76 | $831.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $165.96 Typical High $165.96 | Professional | 55 · Aftercare only | $151.36 | $165.96 | $165.96 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $109.65 Typical High $112.20 | Professional | 56 · Pre-op care only | $100.00 | $109.65 | $112.20 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $501.19 Median $549.54 Typical High $562.34 | Professional | 52 · Reduced service | $501.19 | $549.54 | $562.34 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $223.87 Typical High $223.87 | Professional | 53 · Discontinued | $199.53 | $223.87 | $223.87 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $758.58 Median $831.76 Typical High $831.76 | Professional | 54 · Surgery only | $758.58 | $831.76 | $831.76 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $165.96 Typical High $165.96 | Professional | 55 · Aftercare only | $151.36 | $165.96 | $165.96 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $109.65 Typical High $112.20 | Professional | 56 · Pre-op care only | $100.00 | $109.65 | $112.20 |
Where Pennsylvania sits
The same service costs 15.4 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 $28,500MD $1,851
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.