How much rates vary
Facilitymedian $1,698 · 10th to 90th $427 to $2,630Professionalmedian $617 · 10th to 90th $427 to $1,000
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 $426.58 Median $426.58 Typical High $537.03 | Facility | None | $426.58 | $426.58 | $537.03 |
Aetna Setting Professional Modifier None Typical Low $426.58 Median $537.03 Typical High $891.25 | Professional | None | $426.58 | $537.03 | $891.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $407.38 Median $602.56 Typical High $1,023.29 | Professional | None | $407.38 | $602.56 | $1,023.29 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $616.60 Median $977.24 Typical High $1,513.56 | Professional | 50 · Both sides | $616.60 | $977.24 | $1,513.56 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,862.09 Typical High $2,884.03 | Facility | None | $707.95 | $1,862.09 | $2,884.03 |
Cigna Setting Professional Modifier None Typical Low $562.34 Median $776.25 Typical High $1,000.00 | Professional | None | $562.34 | $776.25 | $1,000.00 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $467.74 Median $707.95 Typical High $1,047.13 | Professional | None | $467.74 | $707.95 | $1,047.13 |
Martin's Point Setting Professional Modifier None Typical Low $426.58 Median $537.03 Typical High $891.25 | Professional | None | $426.58 | $537.03 | $891.25 |
United Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
United Setting Professional Modifier None Typical Low $524.81 Median $707.95 Typical High $933.25 | Professional | None | $524.81 | $707.95 | $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 $213.80 Median $223.87 Typical High $269.15 | Professional | 52 · Reduced service | $213.80 | $223.87 | $269.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $85.11 Median $89.13 Typical High $107.15 | Professional | 53 · Discontinued | $85.11 | $89.13 | $107.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $323.59 Median $331.13 Typical High $407.38 | Professional | 54 · Surgery only | $323.59 | $331.13 | $407.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $64.57 Median $66.07 Typical High $81.28 | Professional | 55 · Aftercare only | $64.57 | $66.07 | $81.28 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $42.66 Median $44.67 Typical High $53.70 | Professional | 56 · Pre-op care only | $42.66 | $44.67 | $53.70 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $309.03 Typical High $380.19 | Professional | 78 · Unplanned return to OR | $302.00 | $309.03 | $380.19 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $213.80 Median $223.87 Typical High $269.15 | Professional | 52 · Reduced service | $213.80 | $223.87 | $269.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $85.11 Median $89.13 Typical High $107.15 | Professional | 53 · Discontinued | $85.11 | $89.13 | $107.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $323.59 Median $331.13 Typical High $407.38 | Professional | 54 · Surgery only | $323.59 | $331.13 | $407.38 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $64.57 Median $66.07 Typical High $81.28 | Professional | 55 · Aftercare only | $64.57 | $66.07 | $81.28 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $42.66 Median $44.67 Typical High $53.70 | Professional | 56 · Pre-op care only | $42.66 | $44.67 | $53.70 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $309.03 Typical High $380.19 | Professional | 78 · Unplanned return to OR | $302.00 | $309.03 | $380.19 |
Where Maine sits
The same service costs 5.4 times more in Wisconsin than in West Virginia. 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 $6,411WV $1,178
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.