How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,000 · 10th to 90th $851 to $1,698
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 $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | None | $831.76 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $707.95 Typical High $707.95 | Professional | 78 · Unplanned return to OR | $588.84 | $707.95 | $707.95 |
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 $1,548.82 Median $1,548.82 Typical High $56,234.13 | Professional | None | $1,548.82 | $1,548.82 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $1,174.90 Typical High $1,584.89 | Professional | 78 · Unplanned return to OR | $741.31 | $1,174.90 | $1,584.89 |
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 $954.99 Median $1,096.48 Typical High $1,995.26 | Professional | None | $954.99 | $1,096.48 | $1,995.26 |
Emblem Health Setting Professional Modifier None Typical Low $1,548.82 Median $1,548.82 Typical High $1,778.28 | Professional | None | $1,548.82 | $1,548.82 | $1,778.28 |
Geisinger Setting Professional Modifier None Typical Low $933.25 Median $1,230.27 Typical High $2,041.74 | Professional | None | $933.25 | $1,230.27 | $2,041.74 |
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 $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | None | $831.76 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $707.95 Typical High $707.95 | Professional | 78 · Unplanned return to OR | $588.84 | $707.95 | $707.95 |
Oscar Health Setting Professional Modifier None Typical Low $1,122.02 Median $1,174.90 Typical High $1,949.84 | Professional | None | $1,122.02 | $1,174.90 | $1,949.84 |
UPMC Health Plan Setting Facility Modifier None Typical Low $954.99 Median $1,230.27 Typical High $1,230.27 | Facility | None | $954.99 | $1,230.27 | $1,230.27 |
UPMC Health Plan Setting Professional Modifier None Typical Low $954.99 Median $1,230.27 Typical High $1,230.27 | Professional | None | $954.99 | $1,230.27 | $1,230.27 |
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 $1,000.00 Median $1,288.25 Typical High $1,995.26 | Professional | None | $1,000.00 | $1,288.25 | $1,995.26 |
11 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 $416.87 Median $501.19 Typical High $501.19 | Professional | 52 · Reduced service | $416.87 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $199.53 Typical High $199.53 | Professional | 53 · Discontinued | $169.82 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $758.58 Typical High $758.58 | Professional | 54 · Surgery only | $630.96 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $151.36 Typical High $151.36 | Professional | 55 · Aftercare only | $125.89 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $100.00 Typical High $100.00 | Professional | 56 · Pre-op care only | $83.18 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $416.87 Median $501.19 Typical High $501.19 | Professional | 52 · Reduced service | $416.87 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $199.53 Typical High $199.53 | Professional | 53 · Discontinued | $169.82 | $199.53 | $199.53 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $758.58 Typical High $758.58 | Professional | 54 · Surgery only | $630.96 | $758.58 | $758.58 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $151.36 Typical High $151.36 | Professional | 55 · Aftercare only | $125.89 | $151.36 | $151.36 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $83.18 Median $100.00 Typical High $100.00 | Professional | 56 · Pre-op care only | $83.18 | $100.00 | $100.00 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $851.14 Median $851.14 Typical High $851.14 | Professional | 62 · Two surgeons | $851.14 | $851.14 | $851.14 |
Where Pennsylvania sits
The same service costs 9.8 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 $16,204MD $1,659
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.