How much rates vary
Facilitymedian $794 · 10th to 90th $288 to $6,166Professionalmedian $2,630 · 10th to 90th $2,239 to $4,467
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 $1,023.29 Median $3,715.35 Typical High $8,511.38 | Facility | None | $1,023.29 | $3,715.35 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $2,187.76 Median $2,630.27 Typical High $3,019.95 | Professional | None | $2,187.76 | $2,630.27 | $3,019.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,548.82 Median $1,862.09 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $1,548.82 | $1,862.09 | $1,862.09 |
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 $4,073.80 Median $4,073.80 Typical High $56,234.13 | Professional | None | $4,073.80 | $4,073.80 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,995.26 Median $3,162.28 Typical High $3,981.07 | Professional | 78 · Unplanned return to OR | $1,995.26 | $3,162.28 | $3,981.07 |
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 $2,454.71 Median $2,818.38 Typical High $5,248.07 | Professional | None | $2,454.71 | $2,818.38 | $5,248.07 |
Emblem Health Setting Professional Modifier None Typical Low $3,981.07 Median $3,981.07 Typical High $4,570.88 | Professional | None | $3,981.07 | $3,981.07 | $4,570.88 |
Geisinger Setting Professional Modifier None Typical Low $2,398.83 Median $3,235.94 Typical High $5,370.32 | Professional | None | $2,398.83 | $3,235.94 | $5,370.32 |
Martin's Point Setting Facility Modifier None Typical Low $1,023.29 Median $3,801.89 Typical High $8,511.38 | Facility | None | $1,023.29 | $3,801.89 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $2,187.76 Median $2,630.27 Typical High $2,691.53 | Professional | None | $2,187.76 | $2,630.27 | $2,691.53 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,548.82 Median $1,862.09 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $1,548.82 | $1,862.09 | $1,862.09 |
Oscar Health Setting Professional Modifier None Typical Low $15.14 Median $2,951.21 Typical High $5,128.61 | Professional | None | $15.14 | $2,951.21 | $5,128.61 |
UPMC Health Plan Setting Facility Modifier None Typical Low $2,511.89 Median $2,951.21 Typical High $2,951.21 | Facility | None | $2,511.89 | $2,951.21 | $2,951.21 |
UPMC Health Plan Setting Professional Modifier None Typical Low $2,511.89 Median $2,951.21 Typical High $2,951.21 | Professional | None | $2,511.89 | $2,951.21 | $2,951.21 |
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 $2,570.40 Median $3,388.44 Typical High $5,248.07 | Professional | None | $2,570.40 | $3,388.44 | $5,248.07 |
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 $1,096.48 Median $1,318.26 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,096.48 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $436.52 Median $524.81 Typical High $524.81 | Professional | 53 · Discontinued | $436.52 | $524.81 | $524.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,659.59 Median $1,995.26 Typical High $1,995.26 | Professional | 54 · Surgery only | $1,659.59 | $1,995.26 | $1,995.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $331.13 Median $398.11 Typical High $398.11 | Professional | 55 · Aftercare only | $331.13 | $398.11 | $398.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $218.78 Median $263.03 Typical High $263.03 | Professional | 56 · Pre-op care only | $218.78 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,096.48 Median $1,318.26 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,096.48 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $436.52 Median $524.81 Typical High $524.81 | Professional | 53 · Discontinued | $436.52 | $524.81 | $524.81 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,659.59 Median $1,995.26 Typical High $1,995.26 | Professional | 54 · Surgery only | $1,659.59 | $1,995.26 | $1,995.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $331.13 Median $398.11 Typical High $398.11 | Professional | 55 · Aftercare only | $331.13 | $398.11 | $398.11 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $218.78 Median $263.03 Typical High $263.03 | Professional | 56 · Pre-op care only | $218.78 | $263.03 | $263.03 |
Where Pennsylvania sits
The same service costs 12.3 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 $35,907WA $2,929
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.