How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,761Professionalmedian $1,950 · 10th to 90th $1,660 to $3,631
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 $8,709.64 | Facility | None | $831.76 | $4,897.79 | $8,709.64 |
Aetna Setting Professional Modifier None Typical Low $1,659.59 Median $1,819.70 Typical High $1,949.84 | Professional | None | $1,659.59 | $1,819.70 | $1,949.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,148.15 Median $1,288.25 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $1,148.15 | $1,288.25 | $1,380.38 |
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 $1,949.84 Median $1,995.26 Typical High $3,801.89 | Professional | None | $1,949.84 | $1,995.26 | $3,801.89 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,479.11 Median $1,513.56 Typical High $2,884.03 | Professional | 78 · Unplanned return to OR | $1,479.11 | $1,513.56 | $2,884.03 |
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 $3,981.07 | Professional | None | $1,737.80 | $1,995.26 | $3,981.07 |
Emblem Health Setting Professional Modifier None Typical Low $2,290.87 Median $3,235.94 Typical High $3,235.94 | Professional | None | $2,290.87 | $3,235.94 | $3,235.94 |
Geisinger Setting Professional Modifier None Typical Low $1,778.28 Median $2,290.87 Typical High $3,981.07 | Professional | None | $1,778.28 | $2,290.87 | $3,981.07 |
Martin's Point Setting Facility Modifier None Typical Low $831.76 Median $4,897.79 Typical High $8,709.64 | Facility | None | $831.76 | $4,897.79 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $1,659.59 Median $1,778.28 Typical High $1,949.84 | Professional | None | $1,659.59 | $1,778.28 | $1,949.84 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,148.15 Median $1,230.27 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $1,148.15 | $1,230.27 | $1,380.38 |
Oscar Health Setting Professional Modifier None Typical Low $12.88 Median $2,290.87 Typical High $3,715.35 | Professional | None | $12.88 | $2,290.87 | $3,715.35 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,905.46 Median $2,290.87 Typical High $2,290.87 | Facility | None | $1,905.46 | $2,290.87 | $2,290.87 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,905.46 Median $2,290.87 Typical High $2,290.87 | Professional | None | $1,905.46 | $2,290.87 | $2,290.87 |
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 $1,862.09 Median $2,511.89 Typical High $3,162.28 | Professional | None | $1,862.09 | $2,511.89 | $3,162.28 |
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 $831.76 Median $912.01 Typical High $977.24 | Professional | 52 · Reduced service | $831.76 | $912.01 | $977.24 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $331.13 Median $363.08 Typical High $398.11 | Professional | 53 · Discontinued | $331.13 | $363.08 | $398.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,230.27 Median $1,380.38 Typical High $1,479.11 | Professional | 54 · Surgery only | $1,230.27 | $1,380.38 | $1,479.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $275.42 Typical High $295.12 | Professional | 55 · Aftercare only | $251.19 | $275.42 | $295.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $165.96 Median $181.97 Typical High $194.98 | Professional | 56 · Pre-op care only | $165.96 | $181.97 | $194.98 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $831.76 Median $891.25 Typical High $977.24 | Professional | 52 · Reduced service | $831.76 | $891.25 | $977.24 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $331.13 Median $354.81 Typical High $398.11 | Professional | 53 · Discontinued | $331.13 | $354.81 | $398.11 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,230.27 Median $1,318.26 Typical High $1,479.11 | Professional | 54 · Surgery only | $1,230.27 | $1,318.26 | $1,479.11 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $263.03 Typical High $295.12 | Professional | 55 · Aftercare only | $251.19 | $263.03 | $295.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $165.96 Median $177.83 Typical High $194.98 | Professional | 56 · Pre-op care only | $165.96 | $177.83 | $194.98 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $1,737.80 Median $1,737.80 Typical High $1,737.80 | Professional | 62 · Two surgeons | $1,737.80 | $1,737.80 | $1,737.80 |
Where Pennsylvania sits
The same service costs 14.0 times more in Maine than in Texas. 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 $34,704TX $2,477
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.