How much rates vary
Facilitymedian $2,239 · 10th to 90th $813 to $3,890Professionalmedian $550 · 10th to 90th $437 to $851
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 $446.68 Median $549.54 Typical High $549.54 | Professional | None | $446.68 | $549.54 | $549.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $436.52 Median $575.44 Typical High $851.14 | Professional | None | $436.52 | $575.44 | $851.14 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $2,238.72 Typical High $2,951.21 | Facility | None | $812.83 | $2,238.72 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $501.19 Median $616.60 Typical High $1,000.00 | Professional | None | $501.19 | $616.60 | $1,000.00 |
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 $436.52 Median $537.03 Typical High $794.33 | Professional | None | $436.52 | $537.03 | $794.33 |
Martin's Point Setting Professional Modifier None Typical Low $467.74 Median $549.54 Typical High $549.54 | Professional | None | $467.74 | $549.54 | $549.54 |
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 $416.87 Median $562.34 Typical High $776.25 | Professional | None | $416.87 | $562.34 | $776.25 |
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 $234.42 Median $275.42 Typical High $275.42 | Professional | 52 · Reduced service | $234.42 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $109.65 Typical High $109.65 | Professional | 53 · Discontinued | $93.33 | $109.65 | $109.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $346.74 Median $416.87 Typical High $416.87 | Professional | 54 · Surgery only | $346.74 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $69.18 Median $83.18 Typical High $83.18 | Professional | 55 · Aftercare only | $69.18 | $83.18 | $83.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $54.95 Typical High $54.95 | Professional | 56 · Pre-op care only | $46.77 | $54.95 | $54.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $323.59 Median $389.05 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $323.59 | $389.05 | $389.05 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $257.04 Median $275.42 Typical High $275.42 | Professional | 52 · Reduced service | $257.04 | $275.42 | $275.42 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $104.71 Median $109.65 Typical High $109.65 | Professional | 53 · Discontinued | $104.71 | $109.65 | $109.65 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $389.05 Median $416.87 Typical High $416.87 | Professional | 54 · Surgery only | $389.05 | $416.87 | $416.87 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $77.62 Median $83.18 Typical High $83.18 | Professional | 55 · Aftercare only | $77.62 | $83.18 | $83.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $51.29 Median $54.95 Typical High $54.95 | Professional | 56 · Pre-op care only | $51.29 | $54.95 | $54.95 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $363.08 Median $389.05 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $363.08 | $389.05 | $389.05 |
Where Maine sits
The same service costs 5.0 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 $7,200MT $1,432
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.