How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $2,291 · 10th to 90th $1,950 to $4,074
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 $1,949.84 Median $2,137.96 Typical High $2,290.87 | Professional | None | $1,949.84 | $2,137.96 | $2,290.87 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,513.56 Typical High $1,621.81 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,513.56 | $1,621.81 |
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 $2,290.87 Median $2,398.83 Typical High $4,466.84 | Professional | None | $2,290.87 | $2,398.83 | $4,466.84 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,737.80 Median $1,819.70 Typical High $3,388.44 | Professional | 78 · Unplanned return to OR | $1,737.80 | $1,819.70 | $3,388.44 |
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 $2,089.30 Median $2,290.87 Typical High $4,786.30 | Professional | None | $2,089.30 | $2,290.87 | $4,786.30 |
Emblem Health Setting Professional Modifier None Typical Low $2,754.23 Median $3,890.45 Typical High $3,890.45 | Professional | None | $2,754.23 | $3,890.45 | $3,890.45 |
Geisinger Setting Professional Modifier None Typical Low $2,089.30 Median $2,754.23 Typical High $4,677.35 | Professional | None | $2,089.30 | $2,754.23 | $4,677.35 |
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 $1,949.84 Median $2,137.96 Typical High $2,290.87 | Professional | None | $1,949.84 | $2,137.96 | $2,290.87 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,445.44 Typical High $1,621.81 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,445.44 | $1,621.81 |
Oscar Health Setting Professional Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $4,365.16 | Professional | None | $2,511.89 | $2,511.89 | $4,365.16 |
UPMC Health Plan Setting Facility Modifier None Typical Low $2,238.72 Median $2,398.83 Typical High $2,398.83 | Facility | None | $2,238.72 | $2,398.83 | $2,398.83 |
UPMC Health Plan Setting Professional Modifier None Typical Low $2,238.72 Median $2,398.83 Typical High $2,398.83 | Professional | None | $2,238.72 | $2,398.83 | $2,398.83 |
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 $2,187.76 Median $3,019.95 Typical High $3,715.35 | Professional | None | $2,187.76 | $3,019.95 | $3,715.35 |
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 $977.24 Median $1,071.52 Typical High $1,148.15 | Professional | 52 · Reduced service | $977.24 | $1,071.52 | $1,148.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $426.58 Typical High $467.74 | Professional | 53 · Discontinued | $389.05 | $426.58 | $467.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,621.81 Typical High $1,737.80 | Professional | 54 · Surgery only | $1,445.44 | $1,621.81 | $1,737.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $295.12 Median $323.59 Typical High $346.74 | Professional | 55 · Aftercare only | $295.12 | $323.59 | $346.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $213.80 Typical High $229.09 | Professional | 56 · Pre-op care only | $194.98 | $213.80 | $229.09 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $977.24 Median $1,047.13 Typical High $1,148.15 | Professional | 52 · Reduced service | $977.24 | $1,047.13 | $1,148.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $416.87 Typical High $467.74 | Professional | 53 · Discontinued | $389.05 | $416.87 | $467.74 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,548.82 Typical High $1,737.80 | Professional | 54 · Surgery only | $1,445.44 | $1,548.82 | $1,737.80 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $295.12 Median $309.03 Typical High $346.74 | Professional | 55 · Aftercare only | $295.12 | $309.03 | $346.74 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $208.93 Typical High $229.09 | Professional | 56 · Pre-op care only | $194.98 | $208.93 | $229.09 |
Where Pennsylvania sits
The same service costs 13.8 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 $35,114TX $2,545
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.