How much rates vary
Facilitymedian $1,778 · 10th to 90th $708 to $3,236Professionalmedian $275 · 10th to 90th $170 to $501
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 Professional Modifier None Typical Low $141.25 Median $204.17 Typical High $346.74 | Professional | None | $141.25 | $204.17 | $346.74 |
Anthem BCBS Setting Professional Modifier None Typical Low $186.21 Median $275.42 Typical High $501.19 | Professional | None | $186.21 | $275.42 | $501.19 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,698.24 Typical High $2,238.72 | Facility | None | $707.95 | $1,698.24 | $2,238.72 |
Cigna Setting Professional Modifier None Typical Low $234.42 Median $354.81 Typical High $501.19 | Professional | None | $234.42 | $354.81 | $501.19 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $218.78 Median $316.23 Typical High $524.81 | Professional | None | $218.78 | $316.23 | $524.81 |
Martin's Point Setting Professional Modifier None Typical Low $141.25 Median $204.17 Typical High $346.74 | Professional | None | $141.25 | $204.17 | $346.74 |
United Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
United Setting Professional Modifier None Typical Low $229.09 Median $316.23 Typical High $436.52 | Professional | None | $229.09 | $316.23 | $436.52 |
12 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 $70.79 Median $91.20 Typical High $102.33 | Professional | 52 · Reduced service | $70.79 | $91.20 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $36.31 Typical High $40.74 | Professional | 53 · Discontinued | $28.18 | $36.31 | $40.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $104.71 Median $134.90 Typical High $151.36 | Professional | 54 · Surgery only | $104.71 | $134.90 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $26.92 Typical High $30.90 | Professional | 55 · Aftercare only | $21.38 | $26.92 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $18.20 Typical High $20.42 | Professional | 56 · Pre-op care only | $14.13 | $18.20 | $20.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $97.72 Median $125.89 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $97.72 | $125.89 | $141.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $70.79 Median $91.20 Typical High $102.33 | Professional | 52 · Reduced service | $70.79 | $91.20 | $102.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $36.31 Typical High $40.74 | Professional | 53 · Discontinued | $28.18 | $36.31 | $40.74 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $104.71 Median $138.04 Typical High $151.36 | Professional | 54 · Surgery only | $104.71 | $138.04 | $151.36 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $27.54 Typical High $30.90 | Professional | 55 · Aftercare only | $21.38 | $27.54 | $30.90 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $18.20 Typical High $20.42 | Professional | 56 · Pre-op care only | $14.13 | $18.20 | $20.42 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $97.72 Median $128.82 Typical High $141.25 | Professional | 78 · Unplanned return to OR | $97.72 | $128.82 | $141.25 |
Where Maine sits
The same service costs 9.3 times more in Colorado than in Montana. 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
CO $5,912MT $637
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.