How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,042 · 10th to 90th $1,698 to $3,467
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 $1,698.24 Median $2,041.74 Typical High $2,454.71 | Professional | None | $1,698.24 | $2,041.74 | $2,454.71 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $1,412.54 Typical High $1,412.54 | Professional | 78 · Unplanned return to OR | $1,202.26 | $1,412.54 | $1,412.54 |
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 $3,162.28 Median $3,162.28 Typical High $56,234.13 | Professional | None | $3,162.28 | $3,162.28 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,513.56 Median $2,398.83 Typical High $3,019.95 | Professional | 78 · Unplanned return to OR | $1,513.56 | $2,398.83 | $3,019.95 |
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 $1,819.70 Median $2,137.96 Typical High $4,073.80 | Professional | None | $1,819.70 | $2,137.96 | $4,073.80 |
Emblem Health Setting Professional Modifier None Typical Low $3,090.30 Median $3,090.30 Typical High $3,548.13 | Professional | None | $3,090.30 | $3,090.30 | $3,548.13 |
Geisinger Setting Professional Modifier None Typical Low $1,778.28 Median $2,454.71 Typical High $4,168.69 | Professional | None | $1,778.28 | $2,454.71 | $4,168.69 |
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 $1,698.24 Median $2,041.74 Typical High $2,884.03 | Professional | None | $1,698.24 | $2,041.74 | $2,884.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $1,412.54 Typical High $1,412.54 | Professional | 78 · Unplanned return to OR | $1,202.26 | $1,412.54 | $1,412.54 |
Oscar Health Setting Professional Modifier None Typical Low $2,041.74 Median $2,238.72 Typical High $3,801.89 | Professional | None | $2,041.74 | $2,238.72 | $3,801.89 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,949.84 Median $2,041.74 Typical High $2,041.74 | Facility | None | $1,949.84 | $2,041.74 | $2,041.74 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,949.84 Median $2,041.74 Typical High $2,041.74 | Professional | None | $1,949.84 | $2,041.74 | $2,041.74 |
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 $1,949.84 Median $2,570.40 Typical High $4,073.80 | Professional | None | $1,949.84 | $2,570.40 | $4,073.80 |
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 $851.14 Median $1,023.29 Typical High $1,023.29 | Professional | 52 · Reduced service | $851.14 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $407.38 Typical High $407.38 | Professional | 53 · Discontinued | $338.84 | $407.38 | $407.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,288.25 Median $1,513.56 Typical High $1,513.56 | Professional | 54 · Surgery only | $1,288.25 | $1,513.56 | $1,513.56 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $302.00 Typical High $309.03 | Professional | 55 · Aftercare only | $257.04 | $302.00 | $309.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $204.17 Typical High $204.17 | Professional | 56 · Pre-op care only | $169.82 | $204.17 | $204.17 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $851.14 Median $1,023.29 Typical High $1,023.29 | Professional | 52 · Reduced service | $851.14 | $1,023.29 | $1,023.29 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $407.38 Typical High $407.38 | Professional | 53 · Discontinued | $338.84 | $407.38 | $407.38 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,288.25 Median $1,513.56 Typical High $1,513.56 | Professional | 54 · Surgery only | $1,288.25 | $1,513.56 | $1,513.56 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $302.00 Typical High $309.03 | Professional | 55 · Aftercare only | $257.04 | $302.00 | $309.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $204.17 Typical High $204.17 | Professional | 56 · Pre-op care only | $169.82 | $204.17 | $204.17 |
Where Pennsylvania sits
The same service costs 13.8 times more in Maine than in Washington. 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 $35,114WA $2,549
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.