How much rates vary
Facilitymedian $1,778 · 10th to 90th $708 to $3,311Professionalmedian $407 · 10th to 90th $302 to $661
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 $239.88 Median $407.38 Typical High $407.38 | Professional | None | $239.88 | $407.38 | $407.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $323.59 Median $389.05 Typical High $660.69 | Professional | None | $323.59 | $389.05 | $660.69 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,949.84 Typical High $2,570.40 | Facility | None | $707.95 | $1,949.84 | $2,570.40 |
Cigna Setting Professional Modifier None Typical Low $316.23 Median $501.19 Typical High $741.31 | Professional | None | $316.23 | $501.19 | $741.31 |
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 $309.03 Median $436.52 Typical High $676.08 | Professional | None | $309.03 | $436.52 | $676.08 |
Martin's Point Setting Professional Modifier None Typical Low $251.19 Median $407.38 Typical High $407.38 | Professional | None | $251.19 | $407.38 | $407.38 |
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 $281.84 Median $380.19 Typical High $602.56 | Professional | None | $281.84 | $380.19 | $602.56 |
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 $131.83 Median $204.17 Typical High $204.17 | Professional | 52 · Reduced service | $131.83 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $52.48 Median $81.28 Typical High $81.28 | Professional | 53 · Discontinued | $52.48 | $81.28 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $194.98 Median $302.00 Typical High $302.00 | Professional | 54 · Surgery only | $194.98 | $302.00 | $302.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $39.81 Median $60.26 Typical High $60.26 | Professional | 55 · Aftercare only | $39.81 | $60.26 | $60.26 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.30 Median $40.74 Typical High $40.74 | Professional | 56 · Pre-op care only | $26.30 | $40.74 | $40.74 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $181.97 Median $281.84 Typical High $281.84 | Professional | 78 · Unplanned return to OR | $181.97 | $281.84 | $281.84 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $151.36 Median $204.17 Typical High $204.17 | Professional | 52 · Reduced service | $151.36 | $204.17 | $204.17 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $60.26 Median $81.28 Typical High $81.28 | Professional | 53 · Discontinued | $60.26 | $81.28 | $81.28 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $223.87 Median $302.00 Typical High $302.00 | Professional | 54 · Surgery only | $223.87 | $302.00 | $302.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $45.71 Median $60.26 Typical High $60.26 | Professional | 55 · Aftercare only | $45.71 | $60.26 | $60.26 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $30.20 Median $40.74 Typical High $40.74 | Professional | 56 · Pre-op care only | $30.20 | $40.74 | $40.74 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $208.93 Median $281.84 Typical High $281.84 | Professional | 78 · Unplanned return to OR | $208.93 | $281.84 | $281.84 |
Where Maine sits
The same service costs 5.5 times more in Colorado than in Michigan. 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 $4,792MI $877
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.