How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $3,236 · 10th to 90th $2,692 to $5,495
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 $2,691.53 Median $3,235.94 Typical High $3,235.94 | Professional | None | $2,691.53 | $3,235.94 | $3,235.94 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,905.46 Median $2,290.87 Typical High $2,290.87 | Professional | 78 · Unplanned return to OR | $1,905.46 | $2,290.87 | $2,290.87 |
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 $5,011.87 Median $5,011.87 Typical High $56,234.13 | Professional | None | $5,011.87 | $5,011.87 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,398.83 Median $3,890.45 Typical High $4,897.79 | Professional | 78 · Unplanned return to OR | $2,398.83 | $3,890.45 | $4,897.79 |
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 $3,019.95 Median $3,388.44 Typical High $6,456.54 | Professional | None | $3,019.95 | $3,388.44 | $6,456.54 |
Emblem Health Setting Professional Modifier None Typical Low $4,786.30 Median $4,786.30 Typical High $5,495.41 | Professional | None | $4,786.30 | $4,786.30 | $5,495.41 |
Geisinger Setting Professional Modifier None Typical Low $2,951.21 Median $3,890.45 Typical High $6,606.93 | Professional | None | $2,951.21 | $3,890.45 | $6,606.93 |
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 $2,691.53 Median $3,235.94 Typical High $3,235.94 | Professional | None | $2,691.53 | $3,235.94 | $3,235.94 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,905.46 Median $2,290.87 Typical High $2,290.87 | Professional | 78 · Unplanned return to OR | $1,905.46 | $2,290.87 | $2,290.87 |
Oscar Health Setting Professional Modifier None Typical Low $10.96 Median $3,548.13 Typical High $6,165.95 | Professional | None | $10.96 | $3,548.13 | $6,165.95 |
UPMC Health Plan Setting Facility Modifier None Typical Low $3,090.30 Median $3,311.31 Typical High $3,311.31 | Facility | None | $3,090.30 | $3,311.31 | $3,311.31 |
UPMC Health Plan Setting Professional Modifier None Typical Low $3,090.30 Median $3,311.31 Typical High $3,311.31 | Professional | None | $3,090.30 | $3,311.31 | $3,311.31 |
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 $3,162.28 Median $4,168.69 Typical High $6,606.93 | Professional | None | $3,162.28 | $4,168.69 | $6,606.93 |
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 $1,348.96 Median $1,621.81 Typical High $1,621.81 | Professional | 52 · Reduced service | $1,348.96 | $1,621.81 | $1,621.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $549.54 Median $645.65 Typical High $645.65 | Professional | 53 · Discontinued | $549.54 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,041.74 Median $2,454.71 Typical High $2,454.71 | Professional | 54 · Surgery only | $2,041.74 | $2,454.71 | $2,454.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $407.38 Median $489.78 Typical High $489.78 | Professional | 55 · Aftercare only | $407.38 | $489.78 | $489.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $269.15 Median $323.59 Typical High $323.59 | Professional | 56 · Pre-op care only | $269.15 | $323.59 | $323.59 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,348.96 Median $1,621.81 Typical High $1,621.81 | Professional | 52 · Reduced service | $1,348.96 | $1,621.81 | $1,621.81 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $549.54 Median $645.65 Typical High $645.65 | Professional | 53 · Discontinued | $549.54 | $645.65 | $645.65 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,041.74 Median $2,454.71 Typical High $2,454.71 | Professional | 54 · Surgery only | $2,041.74 | $2,454.71 | $2,454.71 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $407.38 Median $489.78 Typical High $489.78 | Professional | 55 · Aftercare only | $407.38 | $489.78 | $489.78 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $269.15 Median $323.59 Typical High $323.59 | Professional | 56 · Pre-op care only | $269.15 | $323.59 | $323.59 |
Where Pennsylvania sits
The same service costs 10.8 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 $36,725WA $3,399
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.