How much rates vary
Facilitymedian $2,188 · 10th to 90th $537 to $2,951Professionalmedian $537 · 10th to 90th $417 to $813
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 $537.03 Median $537.03 Typical High $537.03 | Facility | None | $537.03 | $537.03 | $537.03 |
Aetna Setting Professional Modifier None Typical Low $436.52 Median $537.03 Typical High $812.83 | Professional | None | $436.52 | $537.03 | $812.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $416.87 Median $549.54 Typical High $812.83 | Professional | None | $416.87 | $549.54 | $812.83 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $263.03 Median $346.74 Typical High $512.86 | Professional | 62 · Two surgeons | $263.03 | $346.74 | $512.86 |
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 $478.63 Median $588.84 Typical High $870.96 | Professional | None | $478.63 | $588.84 | $870.96 |
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 $416.87 Median $537.03 Typical High $794.33 | Professional | None | $416.87 | $537.03 | $794.33 |
Martin's Point Setting Professional Modifier None Typical Low $436.52 Median $537.03 Typical High $812.83 | Professional | None | $436.52 | $537.03 | $812.83 |
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 $407.38 Median $537.03 Typical High $724.44 | Professional | None | $407.38 | $537.03 | $724.44 |
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 $218.78 Median $269.15 Typical High $269.15 | Professional | 52 · Reduced service | $218.78 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $87.10 Median $107.15 Typical High $107.15 | Professional | 53 · Discontinued | $87.10 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $331.13 Median $407.38 Typical High $407.38 | Professional | 54 · Surgery only | $331.13 | $407.38 | $407.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $81.28 Typical High $81.28 | Professional | 55 · Aftercare only | $66.07 | $81.28 | $81.28 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $53.70 Typical High $53.70 | Professional | 56 · Pre-op care only | $43.65 | $53.70 | $53.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $309.03 Median $380.19 Typical High $380.19 | Professional | 78 · Unplanned return to OR | $309.03 | $380.19 | $380.19 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $245.47 Median $269.15 Typical High $269.15 | Professional | 52 · Reduced service | $245.47 | $269.15 | $269.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $107.15 Typical High $107.15 | Professional | 53 · Discontinued | $100.00 | $107.15 | $107.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $371.54 Median $407.38 Typical High $407.38 | Professional | 54 · Surgery only | $371.54 | $407.38 | $407.38 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $74.13 Median $81.28 Typical High $81.28 | Professional | 55 · Aftercare only | $74.13 | $81.28 | $81.28 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $48.98 Median $53.70 Typical High $53.70 | Professional | 56 · Pre-op care only | $48.98 | $53.70 | $53.70 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $346.74 Median $380.19 Typical High $380.19 | Professional | 78 · Unplanned return to OR | $346.74 | $380.19 | $380.19 |
Where Maine sits
The same service costs 5.1 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 $7,097MT $1,384
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.