How much rates vary
Facilitymedian $87 · 10th to 90th $47 to $708Professionalmedian $100 · 10th to 90th $54 to $219
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 Facility Modifier None Typical Low $46.77 Median $87.10 Typical High $169.82 | Facility | None | $46.77 | $87.10 | $169.82 |
Aetna Setting Professional Modifier None Typical Low $46.77 Median $87.10 Typical High $223.87 | Professional | None | $46.77 | $87.10 | $223.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $57.54 Median $112.20 Typical High $213.80 | Professional | None | $57.54 | $112.20 | $213.80 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $64.57 Median $128.82 Typical High $229.09 | Professional | None | $64.57 | $128.82 | $229.09 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $75.86 Median $131.83 Typical High $229.09 | Professional | None | $75.86 | $131.83 | $229.09 |
Martin's Point Setting Facility Modifier None Typical Low $46.77 Median $87.10 Typical High $19,498.45 | Facility | None | $46.77 | $87.10 | $19,498.45 |
Martin's Point Setting Professional Modifier None Typical Low $46.77 Median $87.10 Typical High $223.87 | Professional | None | $46.77 | $87.10 | $223.87 |
United Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
United Setting Professional Modifier None Typical Low $77.62 Median $125.89 Typical High $190.55 | Professional | None | $77.62 | $125.89 | $190.55 |
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 $23.44 Median $43.65 Typical High $43.65 | Professional | 52 · Reduced service | $23.44 | $43.65 | $43.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $17.38 Typical High $17.78 | Professional | 53 · Discontinued | $9.33 | $17.38 | $17.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $66.07 Typical High $66.07 | Professional | 54 · Surgery only | $35.48 | $66.07 | $66.07 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $13.18 Typical High $13.18 | Professional | 55 · Aftercare only | $7.08 | $13.18 | $13.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $8.71 Typical High $8.71 | Professional | 56 · Pre-op care only | $4.68 | $8.71 | $8.71 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $23.44 Median $29.51 Typical High $43.65 | Professional | 52 · Reduced service | $23.44 | $29.51 | $43.65 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $11.75 Typical High $17.78 | Professional | 53 · Discontinued | $9.33 | $11.75 | $17.78 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $43.65 Typical High $66.07 | Professional | 54 · Surgery only | $35.48 | $43.65 | $66.07 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $8.71 Typical High $13.18 | Professional | 55 · Aftercare only | $7.08 | $8.71 | $13.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $5.89 Typical High $8.71 | Professional | 56 · Pre-op care only | $4.68 | $5.89 | $8.71 |
Where Maine sits
The same service costs 12.9 times more in Colorado than in Maine. 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 $2,408ME $187
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.