How much rates vary
Facilitymedian $794 · 10th to 90th $240 to $6,310Professionalmedian $1,862 · 10th to 90th $1,585 to $3,236
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 $1,548.82 Median $1,737.80 Typical High $1,862.09 | Professional | None | $1,548.82 | $1,737.80 | $1,862.09 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,202.26 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,202.26 | $1,288.25 |
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 $1,819.70 Median $1,905.46 Typical High $3,630.78 | Professional | None | $1,819.70 | $1,905.46 | $3,630.78 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,380.38 Median $1,445.44 Typical High $2,754.23 | Professional | 78 · Unplanned return to OR | $1,380.38 | $1,445.44 | $2,754.23 |
Cigna Setting Facility Modifier None Typical Low $380.19 Median $676.08 Typical High $2,691.53 | Facility | None | $380.19 | $676.08 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,737.80 Median $1,949.84 Typical High $3,890.45 | Professional | None | $1,737.80 | $1,949.84 | $3,890.45 |
Emblem Health Setting Professional Modifier None Typical Low $2,187.76 Median $3,162.28 Typical High $3,162.28 | Professional | None | $2,187.76 | $3,162.28 | $3,162.28 |
Geisinger Setting Professional Modifier None Typical Low $1,659.59 Median $2,187.76 Typical High $3,801.89 | Professional | None | $1,659.59 | $2,187.76 | $3,801.89 |
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 $1,548.82 Median $1,737.80 Typical High $1,862.09 | Professional | None | $1,548.82 | $1,737.80 | $1,862.09 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,174.90 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,174.90 | $1,288.25 |
Oscar Health Setting Professional Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $3,548.13 | Professional | None | $1,949.84 | $1,949.84 | $3,548.13 |
UPMC Health Plan Setting Facility Modifier None Typical Low $1,778.28 Median $1,778.28 Typical High $1,778.28 | Facility | None | $1,778.28 | $1,778.28 | $1,778.28 |
UPMC Health Plan Setting Professional Modifier None Typical Low $1,778.28 Median $1,778.28 Typical High $1,778.28 | Professional | None | $1,778.28 | $1,778.28 | $1,778.28 |
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 $1,737.80 Median $2,398.83 Typical High $3,019.95 | Professional | None | $1,737.80 | $2,398.83 | $3,019.95 |
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 $776.25 Median $851.14 Typical High $933.25 | Professional | 52 · Reduced service | $776.25 | $851.14 | $933.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $346.74 Typical High $371.54 | Professional | 53 · Discontinued | $309.03 | $346.74 | $371.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,288.25 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,174.90 | $1,288.25 | $1,380.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $257.04 Typical High $275.42 | Professional | 55 · Aftercare only | $234.42 | $257.04 | $275.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $173.78 Typical High $186.21 | Professional | 56 · Pre-op care only | $154.88 | $173.78 | $186.21 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $776.25 Median $831.76 Typical High $933.25 | Professional | 52 · Reduced service | $776.25 | $831.76 | $933.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $331.13 Typical High $371.54 | Professional | 53 · Discontinued | $309.03 | $331.13 | $371.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,258.93 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,174.90 | $1,258.93 | $1,380.38 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $251.19 Typical High $275.42 | Professional | 55 · Aftercare only | $234.42 | $251.19 | $275.42 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $165.96 Typical High $186.21 | Professional | 56 · Pre-op care only | $154.88 | $165.96 | $186.21 |
UPMC Health Plan Setting Professional Modifier 62 · Two surgeons Typical Low $1,548.82 Median $1,548.82 Typical High $1,548.82 | Professional | 62 · Two surgeons | $1,548.82 | $1,548.82 | $1,548.82 |
Where Pennsylvania sits
The same service costs 14.4 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 $34,547MD $2,395
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.