How much rates vary
Facilitymedian $933 · 10th to 90th $81 to $1,585Professionalmedian $170 · 10th to 90th $81 to $309
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 $81.28 Median $81.28 Typical High $181.97 | Facility | None | $81.28 | $81.28 | $181.97 |
Aetna Setting Professional Modifier None Typical Low $81.28 Median $177.83 Typical High $288.40 | Professional | None | $81.28 | $177.83 | $288.40 |
Anthem BCBS Setting Professional Modifier None Typical Low $70.79 Median $141.25 Typical High $331.13 | Professional | None | $70.79 | $141.25 | $331.13 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $117.49 Median $213.80 Typical High $489.78 | Professional | 50 · Both sides | $117.49 | $213.80 | $489.78 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $12.59 Median $22.39 Typical High $52.48 | Professional | 80 · Assistant surgeon | $12.59 | $22.39 | $52.48 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $10.96 Median $19.95 Typical High $45.71 | Professional | AS · PA/NP assist | $10.96 | $19.95 | $45.71 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,412.54 Typical High $2,238.72 | Facility | None | $707.95 | $1,412.54 | $2,238.72 |
Cigna Setting Professional Modifier None Typical Low $109.65 Median $204.17 Typical High $338.84 | Professional | None | $109.65 | $204.17 | $338.84 |
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 $79.43 Median $177.83 Typical High $338.84 | Professional | None | $79.43 | $177.83 | $338.84 |
Martin's Point Setting Professional Modifier None Typical Low $81.28 Median $177.83 Typical High $288.40 | Professional | None | $81.28 | $177.83 | $288.40 |
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 $104.71 Median $173.78 Typical High $302.00 | Professional | None | $104.71 | $173.78 | $302.00 |
10 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 $40.74 Median $44.67 Typical High $91.20 | Professional | 52 · Reduced service | $40.74 | $44.67 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.22 Median $17.78 Typical High $36.31 | Professional | 53 · Discontinued | $16.22 | $17.78 | $36.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $60.26 Median $66.07 Typical High $134.90 | Professional | 54 · Surgery only | $60.26 | $66.07 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $13.18 Typical High $26.92 | Professional | 55 · Aftercare only | $12.30 | $13.18 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $8.91 Typical High $18.20 | Professional | 56 · Pre-op care only | $8.13 | $8.91 | $18.20 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $40.74 Median $44.67 Typical High $91.20 | Professional | 52 · Reduced service | $40.74 | $44.67 | $91.20 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $16.22 Median $17.78 Typical High $36.31 | Professional | 53 · Discontinued | $16.22 | $17.78 | $36.31 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $60.26 Median $66.07 Typical High $134.90 | Professional | 54 · Surgery only | $60.26 | $66.07 | $134.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $13.18 Typical High $26.92 | Professional | 55 · Aftercare only | $12.30 | $13.18 | $26.92 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $8.91 Typical High $18.20 | Professional | 56 · Pre-op care only | $8.13 | $8.91 | $18.20 |
Where Maine sits
The same service costs 9.7 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 $4,351MT $447
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.