How much rates vary
Facilitymedian $2,188 · 10th to 90th $708 to $2,951Professionalmedian $708 · 10th to 90th $550 to $1,096
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 $707.95 Median $707.95 Typical High $707.95 | Facility | None | $707.95 | $707.95 | $707.95 |
Aetna Setting Professional Modifier None Typical Low $562.34 Median $707.95 Typical High $707.95 | Professional | None | $562.34 | $707.95 | $707.95 |
Anthem BCBS Setting Professional Modifier None Typical Low $549.54 Median $724.44 Typical High $1,096.48 | Professional | None | $549.54 | $724.44 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $831.76 Median $1,096.48 Typical High $1,659.59 | Professional | 50 · Both sides | $831.76 | $1,096.48 | $1,659.59 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $346.74 Median $457.09 Typical High $691.83 | Professional | 62 · Two surgeons | $346.74 | $457.09 | $691.83 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $2,238.72 Typical High $2,951.21 | Facility | None | $1,000.00 | $2,238.72 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $645.65 Median $794.33 Typical High $1,148.15 | Professional | None | $645.65 | $794.33 | $1,148.15 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $549.54 Median $707.95 Typical High $1,047.13 | Professional | None | $549.54 | $707.95 | $1,047.13 |
Martin's Point Setting Professional Modifier None Typical Low $575.44 Median $707.95 Typical High $707.95 | Professional | None | $575.44 | $707.95 | $707.95 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
United Setting Professional Modifier None Typical Low $537.03 Median $707.95 Typical High $954.99 | Professional | None | $537.03 | $707.95 | $954.99 |
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 $295.12 Median $354.81 Typical High $354.81 | Professional | 52 · Reduced service | $295.12 | $354.81 | $354.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $117.49 Median $141.25 Typical High $141.25 | Professional | 53 · Discontinued | $117.49 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $436.52 Median $537.03 Typical High $537.03 | Professional | 54 · Surgery only | $436.52 | $537.03 | $537.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $87.10 Median $107.15 Typical High $107.15 | Professional | 55 · Aftercare only | $87.10 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $58.88 Median $70.79 Typical High $70.79 | Professional | 56 · Pre-op care only | $58.88 | $70.79 | $70.79 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $407.38 Median $501.19 Typical High $501.19 | Professional | 78 · Unplanned return to OR | $407.38 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $338.84 Median $354.81 Typical High $354.81 | Professional | 52 · Reduced service | $338.84 | $354.81 | $354.81 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $134.90 Median $141.25 Typical High $141.25 | Professional | 53 · Discontinued | $134.90 | $141.25 | $141.25 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $501.19 Median $537.03 Typical High $537.03 | Professional | 54 · Surgery only | $501.19 | $537.03 | $537.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $100.00 Median $107.15 Typical High $107.15 | Professional | 55 · Aftercare only | $100.00 | $107.15 | $107.15 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $67.61 Median $70.79 Typical High $70.79 | Professional | 56 · Pre-op care only | $67.61 | $70.79 | $70.79 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $467.74 Median $501.19 Typical High $501.19 | Professional | 78 · Unplanned return to OR | $467.74 | $501.19 | $501.19 |
Where Maine sits
The same service costs 4.1 times more in Wisconsin 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
WI $7,505MT $1,845
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.