How much rates vary
Facilitymedian $2,239 · 10th to 90th $813 to $3,890Professionalmedian $692 · 10th to 90th $525 to $1,023
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 $537.03 Median $691.83 Typical High $691.83 | Professional | None | $537.03 | $691.83 | $691.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $524.81 Median $676.08 Typical High $1,023.29 | Professional | None | $524.81 | $676.08 | $1,023.29 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $776.25 Median $1,023.29 Typical High $1,548.82 | Professional | 50 · Both sides | $776.25 | $1,023.29 | $1,548.82 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $331.13 Median $426.58 Typical High $645.65 | Professional | 62 · Two surgeons | $331.13 | $426.58 | $645.65 |
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 $602.56 Median $741.31 Typical High $1,122.02 | Professional | None | $602.56 | $741.31 | $1,122.02 |
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 $537.03 Median $691.83 Typical High $977.24 | Professional | None | $537.03 | $691.83 | $977.24 |
Martin's Point Setting Professional Modifier None Typical Low $537.03 Median $691.83 Typical High $691.83 | Professional | None | $537.03 | $691.83 | $691.83 |
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 $524.81 Median $691.83 Typical High $933.25 | Professional | None | $524.81 | $691.83 | $933.25 |
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 $281.84 Median $346.74 Typical High $346.74 | Professional | 52 · Reduced service | $281.84 | $346.74 | $346.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $112.20 Median $138.04 Typical High $138.04 | Professional | 53 · Discontinued | $112.20 | $138.04 | $138.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $426.58 Median $512.86 Typical High $512.86 | Professional | 54 · Surgery only | $426.58 | $512.86 | $512.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $85.11 Median $102.33 Typical High $102.33 | Professional | 55 · Aftercare only | $85.11 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $56.23 Median $69.18 Typical High $69.18 | Professional | 56 · Pre-op care only | $56.23 | $69.18 | $69.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $398.11 Median $478.63 Typical High $478.63 | Professional | 78 · Unplanned return to OR | $398.11 | $478.63 | $478.63 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $316.23 Median $346.74 Typical High $346.74 | Professional | 52 · Reduced service | $316.23 | $346.74 | $346.74 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $125.89 Median $138.04 Typical High $138.04 | Professional | 53 · Discontinued | $125.89 | $138.04 | $138.04 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $467.74 Median $512.86 Typical High $512.86 | Professional | 54 · Surgery only | $467.74 | $512.86 | $512.86 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $102.33 Typical High $102.33 | Professional | 55 · Aftercare only | $95.50 | $102.33 | $102.33 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $63.10 Median $69.18 Typical High $69.18 | Professional | 56 · Pre-op care only | $63.10 | $69.18 | $69.18 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $436.52 Median $478.63 Typical High $478.63 | Professional | 78 · Unplanned return to OR | $436.52 | $478.63 | $478.63 |
Where Maine sits
The same service costs 4.3 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 $7,406MT $1,722
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.