How much rates vary
Facilitymedian $1,585 · 10th to 90th $513 to $11,482Professionalmedian $1,622 · 10th to 90th $1,202 to $2,570
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $933.25 Median $1,905.46 Typical High $7,762.47 | Facility | None | $933.25 | $1,905.46 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $1,698.24 | Professional | None | $1,202.26 | $1,412.54 | $1,698.24 |
BCBS Illinois Setting Facility Modifier None Typical Low $6,165.95 Median $13,182.57 Typical High $26,915.35 | Facility | None | $6,165.95 | $13,182.57 | $26,915.35 |
BCBS Illinois Setting Professional Modifier None Typical Low $1,348.96 Median $1,621.81 Typical High $1,819.70 | Professional | None | $1,348.96 | $1,621.81 | $1,819.70 |
Cigna Setting Facility Modifier None Typical Low $512.86 Median $758.58 Typical High $2,511.89 | Facility | None | $512.86 | $758.58 | $2,511.89 |
Cigna Setting Professional Modifier None Typical Low $1,230.27 Median $1,621.81 Typical High $2,187.76 | Professional | None | $1,230.27 | $1,621.81 | $2,187.76 |
Hally Health Setting Professional Modifier None Typical Low $1,096.48 Median $1,819.70 Typical High $3,981.07 | Professional | None | $1,096.48 | $1,819.70 | $3,981.07 |
Hally Health Setting Facility Modifier None Typical Low $100.00 Median $100.00 Typical High $100.00 | Facility | None | $100.00 | $100.00 | $100.00 |
Hally Health Setting Professional Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $1,584.89 | Professional | None | $1,202.26 | $1,412.54 | $1,584.89 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
United Setting Facility Modifier None Typical Low $489.78 Median $1,258.93 Typical High $7,079.46 | Facility | None | $489.78 | $1,258.93 | $7,079.46 |
United Setting Professional Modifier None Typical Low $1,258.93 Median $1,737.80 Typical High $2,691.53 | Professional | None | $1,258.93 | $1,737.80 | $2,691.53 |
6 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 $616.60 Median $707.95 Typical High $707.95 | Professional | 52 · Reduced service | $616.60 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $281.84 Typical High $281.84 | Professional | 53 · Discontinued | $251.19 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $1,047.13 Typical High $1,047.13 | Professional | 54 · Surgery only | $933.25 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $208.93 Typical High $208.93 | Professional | 55 · Aftercare only | $186.21 | $208.93 | $208.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $141.25 Typical High $141.25 | Professional | 56 · Pre-op care only | $125.89 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $977.24 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $870.96 | $977.24 | $977.24 |
Where Illinois sits
The same service costs 8.2 times more in Maine than in Maryland. 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
ME $15,747MD $1,911
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.