How much rates vary
Facilitymedian $2,239 · 10th to 90th $1,000 to $3,890Professionalmedian $617 · 10th to 90th $490 to $955
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 $501.19 Median $616.60 Typical High $912.01 | Professional | None | $501.19 | $616.60 | $912.01 |
Anthem BCBS Setting Professional Modifier None Typical Low $489.78 Median $630.96 Typical High $954.99 | Professional | None | $489.78 | $630.96 | $954.99 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $724.44 Median $954.99 Typical High $1,412.54 | Professional | 50 · Both sides | $724.44 | $954.99 | $1,412.54 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $309.03 Median $398.11 Typical High $602.56 | Professional | 62 · Two surgeons | $309.03 | $398.11 | $602.56 |
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 $562.34 Median $691.83 Typical High $1,023.29 | Professional | None | $562.34 | $691.83 | $1,023.29 |
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 $467.74 Median $602.56 Typical High $891.25 | Professional | None | $467.74 | $602.56 | $891.25 |
Martin's Point Setting Professional Modifier None Typical Low $524.81 Median $616.60 Typical High $912.01 | Professional | None | $524.81 | $616.60 | $912.01 |
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 $457.09 Median $602.56 Typical High $812.83 | Professional | None | $457.09 | $602.56 | $812.83 |
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 $251.19 Median $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $251.19 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $123.03 Typical High $123.03 | Professional | 53 · Discontinued | $100.00 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $380.19 Median $457.09 Typical High $457.09 | Professional | 54 · Surgery only | $380.19 | $457.09 | $457.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $75.86 Median $91.20 Typical High $91.20 | Professional | 55 · Aftercare only | $75.86 | $91.20 | $91.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $50.12 Median $61.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $50.12 | $61.66 | $61.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $354.81 Median $426.58 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $354.81 | $426.58 | $426.58 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $288.40 Median $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $288.40 | $309.03 | $309.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $114.82 Median $123.03 Typical High $123.03 | Professional | 53 · Discontinued | $114.82 | $123.03 | $123.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $436.52 Median $457.09 Typical High $457.09 | Professional | 54 · Surgery only | $436.52 | $457.09 | $457.09 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $87.10 Median $91.20 Typical High $91.20 | Professional | 55 · Aftercare only | $87.10 | $91.20 | $91.20 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $57.54 Median $61.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $57.54 | $61.66 | $61.66 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $407.38 Median $426.58 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $407.38 | $426.58 | $426.58 |
Where Maine sits
The same service costs 4.6 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 $7,256MT $1,571
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.