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 $524.81 Median $616.60 Typical High $933.25 | Professional | None | $524.81 | $616.60 | $933.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $489.78 Median $645.65 Typical High $954.99 | Professional | None | $489.78 | $645.65 | $954.99 |
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 $575.44 Median $691.83 Typical High $1,071.52 | Professional | None | $575.44 | $691.83 | $1,071.52 |
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 $489.78 Median $602.56 Typical High $912.01 | Professional | None | $489.78 | $602.56 | $912.01 |
Martin's Point Setting Professional Modifier None Typical Low $524.81 Median $616.60 Typical High $933.25 | Professional | None | $524.81 | $616.60 | $933.25 |
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 $478.63 Median $630.96 Typical High $831.76 | Professional | None | $478.63 | $630.96 | $831.76 |
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 $263.03 Median $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $263.03 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $104.71 Median $125.89 Typical High $125.89 | Professional | 53 · Discontinued | $104.71 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $398.11 Median $467.74 Typical High $467.74 | Professional | 54 · Surgery only | $398.11 | $467.74 | $467.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $79.43 Median $93.33 Typical High $93.33 | Professional | 55 · Aftercare only | $79.43 | $93.33 | $93.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $52.48 Median $61.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $52.48 | $61.66 | $61.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $371.54 Median $436.52 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $371.54 | $436.52 | $436.52 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $295.12 Median $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $295.12 | $309.03 | $309.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $117.49 Median $125.89 Typical High $125.89 | Professional | 53 · Discontinued | $117.49 | $125.89 | $125.89 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $436.52 Median $467.74 Typical High $467.74 | Professional | 54 · Surgery only | $436.52 | $467.74 | $467.74 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $87.10 Median $93.33 Typical High $93.33 | Professional | 55 · Aftercare only | $87.10 | $93.33 | $93.33 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $58.88 Median $61.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $58.88 | $61.66 | $61.66 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $407.38 Median $436.52 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $407.38 | $436.52 | $436.52 |
Where Maine sits
The same service costs 4.5 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 $7,285MT $1,607
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.