How much rates vary
Facilitymedian $1,259 · 10th to 90th $537 to $1,820Professionalmedian $158 · 10th to 90th $95 to $263
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 $95.50 Median $138.04 Typical High $138.04 | Professional | None | $95.50 | $138.04 | $138.04 |
Anthem BCBS Setting Professional Modifier None Typical Low $95.50 Median $158.49 Typical High $263.03 | Professional | None | $95.50 | $158.49 | $263.03 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,412.54 Typical High $2,041.74 | Facility | None | $537.03 | $1,412.54 | $2,041.74 |
Cigna Setting Professional Modifier None Typical Low $131.83 Median $194.98 Typical High $269.15 | Professional | None | $131.83 | $194.98 | $269.15 |
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 $112.20 Median $177.83 Typical High $275.42 | Professional | None | $112.20 | $177.83 | $275.42 |
Martin's Point Setting Professional Modifier None Typical Low $95.50 Median $138.04 Typical High $138.04 | Professional | None | $95.50 | $138.04 | $138.04 |
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 $123.03 Median $173.78 Typical High $245.47 | Professional | None | $123.03 | $173.78 | $245.47 |
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 $47.86 Median $69.18 Typical High $69.18 | Professional | 52 · Reduced service | $47.86 | $69.18 | $69.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $27.54 Typical High $27.54 | Professional | 53 · Discontinued | $19.05 | $27.54 | $27.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $70.79 Median $102.33 Typical High $102.33 | Professional | 54 · Surgery only | $70.79 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.13 Median $20.89 Typical High $20.89 | Professional | 55 · Aftercare only | $14.13 | $20.89 | $20.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $13.80 Typical High $13.80 | Professional | 56 · Pre-op care only | $9.55 | $13.80 | $13.80 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $66.07 Median $95.50 Typical High $95.50 | Professional | 78 · Unplanned return to OR | $66.07 | $95.50 | $95.50 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $47.86 Median $69.18 Typical High $69.18 | Professional | 52 · Reduced service | $47.86 | $69.18 | $69.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $27.54 Typical High $27.54 | Professional | 53 · Discontinued | $19.05 | $27.54 | $27.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $70.79 Median $102.33 Typical High $102.33 | Professional | 54 · Surgery only | $70.79 | $102.33 | $102.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $14.13 Median $20.89 Typical High $20.89 | Professional | 55 · Aftercare only | $14.13 | $20.89 | $20.89 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $13.80 Typical High $13.80 | Professional | 56 · Pre-op care only | $9.55 | $13.80 | $13.80 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $66.07 Median $95.50 Typical High $95.50 | Professional | 78 · Unplanned return to OR | $66.07 | $95.50 | $95.50 |
Where Maine sits
The same service costs 13.0 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 $4,547MT $350
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.