How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,288 · 10th to 90th $1,072 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 $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 $1,071.52 Median $1,258.93 Typical High $1,288.25 | Professional | None | $1,071.52 | $1,258.93 | $1,288.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $891.25 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $741.31 | $891.25 | $891.25 |
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 $954.99 Median $1,513.56 Typical High $1,905.46 | Professional | 78 · Unplanned return to OR | $954.99 | $1,513.56 | $1,905.46 |
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 $1,174.90 Median $1,348.96 Typical High $2,511.89 | Professional | None | $1,174.90 | $1,348.96 | $2,511.89 |
Emblem Health Setting Professional Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $2,238.72 | Professional | None | $1,949.84 | $1,949.84 | $2,238.72 |
Geisinger Setting Professional Modifier None Typical Low $1,148.15 Median $1,548.82 Typical High $2,630.27 | Professional | None | $1,148.15 | $1,548.82 | $2,630.27 |
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 $1,071.52 Median $1,258.93 Typical High $1,288.25 | Professional | None | $1,071.52 | $1,258.93 | $1,288.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $891.25 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $741.31 | $891.25 | $891.25 |
Oscar Health Setting Professional Modifier None Typical Low $1,380.38 Median $1,445.44 Typical High $2,398.83 | Professional | None | $1,380.38 | $1,445.44 | $2,398.83 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,202.26 Median $1,445.44 Typical High $1,445.44 | Facility | None | $1,202.26 | $1,445.44 | $1,445.44 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,202.26 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,202.26 | $1,445.44 | $1,445.44 |
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 $1,258.93 Median $1,621.81 Typical High $2,511.89 | Professional | None | $1,258.93 | $1,621.81 | $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 $537.03 Median $630.96 Typical High $645.65 | Professional | 52 · Reduced service | $537.03 | $630.96 | $645.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $213.80 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $213.80 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $954.99 Typical High $954.99 | Professional | 54 · Surgery only | $794.33 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $190.55 Typical High $190.55 | Professional | 55 · Aftercare only | $158.49 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $107.15 Median $125.89 Typical High $128.82 | Professional | 56 · Pre-op care only | $107.15 | $125.89 | $128.82 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $537.03 Median $630.96 Typical High $645.65 | Professional | 52 · Reduced service | $537.03 | $630.96 | $645.65 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $213.80 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $213.80 | $257.04 | $257.04 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $954.99 Typical High $954.99 | Professional | 54 · Surgery only | $794.33 | $954.99 | $954.99 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $190.55 Typical High $190.55 | Professional | 55 · Aftercare only | $158.49 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $107.15 Median $125.89 Typical High $128.82 | Professional | 56 · Pre-op care only | $107.15 | $125.89 | $128.82 |
Where Pennsylvania sits
The same service costs 8.5 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 $16,489MD $1,943
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.