How much rates vary
Facilitymedian $1,778 · 10th to 90th $708 to $3,311Professionalmedian $661 · 10th to 90th $457 to $1,047
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 $478.63 Median $478.63 Typical High $660.69 | Professional | None | $478.63 | $478.63 | $660.69 |
Anthem BCBS Setting Professional Modifier None Typical Low $398.11 Median $630.96 Typical High $1,047.13 | Professional | None | $398.11 | $630.96 | $1,047.13 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,862.09 Typical High $2,691.53 | Facility | None | $707.95 | $1,862.09 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $512.86 Median $741.31 Typical High $1,148.15 | Professional | None | $512.86 | $741.31 | $1,148.15 |
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 $457.09 Median $707.95 Typical High $1,096.48 | Professional | None | $457.09 | $707.95 | $1,096.48 |
Martin's Point Setting Professional Modifier None Typical Low $478.63 Median $478.63 Typical High $660.69 | Professional | None | $478.63 | $478.63 | $660.69 |
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 $512.86 Median $691.83 Typical High $977.24 | Professional | None | $512.86 | $691.83 | $977.24 |
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 $239.88 Median $239.88 Typical High $331.13 | Professional | 52 · Reduced service | $239.88 | $239.88 | $331.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $95.50 Median $95.50 Typical High $131.83 | Professional | 53 · Discontinued | $95.50 | $95.50 | $131.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $363.08 Median $363.08 Typical High $489.78 | Professional | 54 · Surgery only | $363.08 | $363.08 | $489.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $72.44 Median $72.44 Typical High $100.00 | Professional | 55 · Aftercare only | $72.44 | $72.44 | $100.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $47.86 Median $47.86 Typical High $66.07 | Professional | 56 · Pre-op care only | $47.86 | $47.86 | $66.07 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $338.84 Median $338.84 Typical High $457.09 | Professional | 78 · Unplanned return to OR | $338.84 | $338.84 | $457.09 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $239.88 Median $239.88 Typical High $331.13 | Professional | 52 · Reduced service | $239.88 | $239.88 | $331.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $95.50 Median $95.50 Typical High $131.83 | Professional | 53 · Discontinued | $95.50 | $95.50 | $131.83 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $363.08 Median $363.08 Typical High $489.78 | Professional | 54 · Surgery only | $363.08 | $363.08 | $489.78 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $72.44 Median $72.44 Typical High $100.00 | Professional | 55 · Aftercare only | $72.44 | $72.44 | $100.00 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $47.86 Median $47.86 Typical High $66.07 | Professional | 56 · Pre-op care only | $47.86 | $47.86 | $66.07 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $338.84 Median $338.84 Typical High $457.09 | Professional | 78 · Unplanned return to OR | $338.84 | $338.84 | $457.09 |
Where Maine sits
The same service costs 4.6 times more in Oklahoma 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
OK $6,614MT $1,440
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.