How much rates vary
Facilitymedian $1,259 · 10th to 90th $708 to $1,862Professionalmedian $407 · 10th to 90th $316 to $631
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 $331.13 Median $407.38 Typical High $407.38 | Professional | None | $331.13 | $407.38 | $407.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $323.59 Median $426.58 Typical High $630.96 | Professional | None | $323.59 | $426.58 | $630.96 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $489.78 Median $630.96 Typical High $954.99 | Professional | 50 · Both sides | $489.78 | $630.96 | $954.99 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,174.90 Typical High $1,862.09 | Facility | None | $707.95 | $1,174.90 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $346.74 Median $457.09 Typical High $660.69 | Professional | None | $346.74 | $457.09 | $660.69 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $309.03 Median $389.05 Typical High $602.56 | Professional | None | $309.03 | $389.05 | $602.56 |
Martin's Point Setting Professional Modifier None Typical Low $380.19 Median $407.38 Typical High $407.38 | Professional | None | $380.19 | $407.38 | $407.38 |
United Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
United Setting Professional Modifier None Typical Low $281.84 Median $389.05 Typical High $549.54 | Professional | None | $281.84 | $389.05 | $549.54 |
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 $165.96 Median $204.17 Typical High $204.17 | Professional | 52 · Reduced service | $165.96 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $67.61 Median $81.28 Typical High $81.28 | Professional | 53 · Discontinued | $67.61 | $81.28 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $251.19 Median $302.00 Typical High $302.00 | Professional | 54 · Surgery only | $251.19 | $302.00 | $302.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $50.12 Median $61.66 Typical High $61.66 | Professional | 55 · Aftercare only | $50.12 | $61.66 | $61.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $33.11 Median $40.74 Typical High $40.74 | Professional | 56 · Pre-op care only | $33.11 | $40.74 | $40.74 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $234.42 Median $281.84 Typical High $281.84 | Professional | 78 · Unplanned return to OR | $234.42 | $281.84 | $281.84 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $190.55 Median $204.17 Typical High $204.17 | Professional | 52 · Reduced service | $190.55 | $204.17 | $204.17 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $75.86 Median $81.28 Typical High $81.28 | Professional | 53 · Discontinued | $75.86 | $81.28 | $81.28 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $288.40 Median $302.00 Typical High $302.00 | Professional | 54 · Surgery only | $288.40 | $302.00 | $302.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $57.54 Median $61.66 Typical High $61.66 | Professional | 55 · Aftercare only | $57.54 | $61.66 | $61.66 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $38.02 Median $40.74 Typical High $40.74 | Professional | 56 · Pre-op care only | $38.02 | $40.74 | $40.74 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $269.15 Median $281.84 Typical High $281.84 | Professional | 78 · Unplanned return to OR | $269.15 | $281.84 | $281.84 |
Where Maine sits
The same service costs 4.6 times more in Colorado 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
CO $4,822MT $1,050
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.