How much rates vary
Facilitymedian $1,318 · 10th to 90th $933 to $6,026Professionalmedian $380 · 10th to 90th $288 to $562
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 $331.13 Median $354.81 Typical High $354.81 | Professional | None | $331.13 | $354.81 | $354.81 |
Anthem BCBS Setting Facility Modifier None Typical Low $4,168.69 Median $4,168.69 Typical High $5,248.07 | Facility | None | $4,168.69 | $4,168.69 | $5,248.07 |
Anthem BCBS Setting Professional Modifier None Typical Low $275.42 Median $389.05 Typical High $562.34 | Professional | None | $275.42 | $389.05 | $562.34 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $5,011.87 Typical High $7,943.28 | Facility | None | $707.95 | $5,011.87 | $7,943.28 |
Cigna Setting Professional Modifier None Typical Low $380.19 Median $416.87 Typical High $630.96 | Professional | None | $380.19 | $416.87 | $630.96 |
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 $295.12 Median $380.19 Typical High $562.34 | Professional | None | $295.12 | $380.19 | $562.34 |
Martin's Point Setting Professional Modifier None Typical Low $331.13 Median $354.81 Typical High $354.81 | Professional | None | $331.13 | $354.81 | $354.81 |
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 $288.40 Median $407.38 Typical High $575.44 | Professional | None | $288.40 | $407.38 | $575.44 |
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 $169.82 Median $173.78 Typical High $173.78 | Professional | 52 · Reduced service | $169.82 | $173.78 | $173.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $70.79 Typical High $70.79 | Professional | 53 · Discontinued | $69.18 | $70.79 | $70.79 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $257.04 Median $263.03 Typical High $263.03 | Professional | 54 · Surgery only | $257.04 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $51.29 Median $52.48 Typical High $52.48 | Professional | 55 · Aftercare only | $51.29 | $52.48 | $52.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $35.48 Typical High $35.48 | Professional | 56 · Pre-op care only | $34.67 | $35.48 | $35.48 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | 52 · Reduced service | $173.78 | $173.78 | $173.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $70.79 Typical High $70.79 | Professional | 53 · Discontinued | $69.18 | $70.79 | $70.79 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $257.04 Median $263.03 Typical High $263.03 | Professional | 54 · Surgery only | $257.04 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $51.29 Median $52.48 Typical High $52.48 | Professional | 55 · Aftercare only | $51.29 | $52.48 | $52.48 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $35.48 Typical High $35.48 | Professional | 56 · Pre-op care only | $34.67 | $35.48 | $35.48 |
Where Maine sits
The same service costs 7.8 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 $7,005MT $893
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.