How much rates vary
Facilitymedian $2,570 · 10th to 90th $724 to $6,310Professionalmedian $724 · 10th to 90th $562 to $1,122
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 $724.44 Median $724.44 Typical High $724.44 | Facility | None | $724.44 | $724.44 | $724.44 |
Aetna Setting Professional Modifier None Typical Low $588.84 Median $724.44 Typical High $1,071.52 | Professional | None | $588.84 | $724.44 | $1,071.52 |
Anthem BCBS Setting Professional Modifier None Typical Low $575.44 Median $741.31 Typical High $1,122.02 | Professional | None | $575.44 | $741.31 | $1,122.02 |
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 $602.56 Median $812.83 Typical High $1,174.90 | Professional | None | $602.56 | $812.83 | $1,174.90 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
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 $588.84 Median $724.44 Typical High $1,071.52 | Professional | None | $588.84 | $724.44 | $1,071.52 |
United Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
United Setting Professional Modifier None Typical Low $501.19 Median $707.95 Typical High $977.24 | Professional | None | $501.19 | $707.95 | $977.24 |
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 $363.08 Typical High $363.08 | Professional | 52 · Reduced service | $295.12 | $363.08 | $363.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $117.49 Median $144.54 Typical High $144.54 | Professional | 53 · Discontinued | $117.49 | $144.54 | $144.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $446.68 Median $549.54 Typical High $549.54 | Professional | 54 · Surgery only | $446.68 | $549.54 | $549.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $89.13 Median $109.65 Typical High $109.65 | Professional | 55 · Aftercare only | $89.13 | $109.65 | $109.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $58.88 Median $72.44 Typical High $72.44 | Professional | 56 · Pre-op care only | $58.88 | $72.44 | $72.44 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $416.87 Median $512.86 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $416.87 | $512.86 | $512.86 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $338.84 Median $363.08 Typical High $363.08 | Professional | 52 · Reduced service | $338.84 | $363.08 | $363.08 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $134.90 Median $144.54 Typical High $144.54 | Professional | 53 · Discontinued | $134.90 | $144.54 | $144.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $512.86 Median $549.54 Typical High $549.54 | Professional | 54 · Surgery only | $512.86 | $549.54 | $549.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $102.33 Median $109.65 Typical High $109.65 | Professional | 55 · Aftercare only | $102.33 | $109.65 | $109.65 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $67.61 Median $72.44 Typical High $72.44 | Professional | 56 · Pre-op care only | $67.61 | $72.44 | $72.44 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $478.63 Median $512.86 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $478.63 | $512.86 | $512.86 |
Where Maine sits
The same service costs 4.7 times more in Oklahoma 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
OK $8,820MT $1,888
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.