How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,905 · 10th to 90th $1,622 to $3,236
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 $1,621.81 Median $1,862.09 Typical High $1,905.46 | Professional | None | $1,621.81 | $1,862.09 | $1,905.46 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,318.26 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,318.26 | $1,348.96 |
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 $2,951.21 Median $2,951.21 Typical High $56,234.13 | Professional | None | $2,951.21 | $2,951.21 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $2,290.87 Typical High $2,818.38 | Professional | 78 · Unplanned return to OR | $1,445.44 | $2,290.87 | $2,818.38 |
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 $1,737.80 Median $1,995.26 Typical High $3,801.89 | Professional | None | $1,737.80 | $1,995.26 | $3,801.89 |
Emblem Health Setting Professional Modifier None Typical Low $2,884.03 Median $2,884.03 Typical High $3,311.31 | Professional | None | $2,884.03 | $2,884.03 | $3,311.31 |
Geisinger Setting Professional Modifier None Typical Low $1,698.24 Median $2,290.87 Typical High $3,890.45 | Professional | None | $1,698.24 | $2,290.87 | $3,890.45 |
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 $1,621.81 Median $1,862.09 Typical High $1,905.46 | Professional | None | $1,621.81 | $1,862.09 | $1,905.46 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,318.26 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,318.26 | $1,348.96 |
Oscar Health Setting Professional Modifier None Typical Low $10.96 Median $2,089.30 Typical High $3,630.78 | Professional | None | $10.96 | $2,089.30 | $3,630.78 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,819.70 Median $2,187.76 Typical High $2,187.76 | Facility | None | $1,819.70 | $2,187.76 | $2,187.76 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,819.70 Median $2,187.76 Typical High $2,187.76 | Professional | None | $1,819.70 | $2,187.76 | $2,187.76 |
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 $1,905.46 Median $2,454.71 Typical High $3,801.89 | Professional | None | $1,905.46 | $2,454.71 | $3,801.89 |
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 $794.33 Median $954.99 Typical High $954.99 | Professional | 52 · Reduced service | $794.33 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $380.19 Typical High $380.19 | Professional | 53 · Discontinued | $323.59 | $380.19 | $380.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,412.54 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,202.26 | $1,412.54 | $1,445.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $239.88 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $190.55 Typical High $190.55 | Professional | 56 · Pre-op care only | $162.18 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $794.33 Median $954.99 Typical High $954.99 | Professional | 52 · Reduced service | $794.33 | $954.99 | $954.99 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $380.19 Typical High $380.19 | Professional | 53 · Discontinued | $323.59 | $380.19 | $380.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,412.54 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,202.26 | $1,412.54 | $1,445.44 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $239.88 | $288.40 | $288.40 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $190.55 Typical High $190.55 | Professional | 56 · Pre-op care only | $162.18 | $190.55 | $190.55 |
Where Pennsylvania sits
The same service costs 13.4 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 $34,930MD $2,604
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.