How much rates vary
Facilitymedian $1,259 · 10th to 90th $537 to $1,820Professionalmedian $214 · 10th to 90th $129 to $372
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 $128.82 Median $186.21 Typical High $275.42 | Professional | None | $128.82 | $186.21 | $275.42 |
Anthem BCBS Setting Professional Modifier None Typical Low $128.82 Median $213.80 Typical High $371.54 | Professional | None | $128.82 | $213.80 | $371.54 |
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 $177.83 Median $269.15 Typical High $380.19 | Professional | None | $177.83 | $269.15 | $380.19 |
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 $151.36 Median $234.42 Typical High $380.19 | Professional | None | $151.36 | $234.42 | $380.19 |
Martin's Point Setting Professional Modifier None Typical Low $128.82 Median $186.21 Typical High $275.42 | Professional | None | $128.82 | $186.21 | $275.42 |
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 $169.82 Median $229.09 Typical High $338.84 | Professional | None | $169.82 | $229.09 | $338.84 |
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 $64.57 Median $93.33 Typical High $93.33 | Professional | 52 · Reduced service | $64.57 | $93.33 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $37.15 Typical High $37.15 | Professional | 53 · Discontinued | $25.70 | $37.15 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $141.25 Typical High $141.25 | Professional | 54 · Surgery only | $97.72 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $28.18 Typical High $28.18 | Professional | 55 · Aftercare only | $19.50 | $28.18 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $18.62 Typical High $18.62 | Professional | 56 · Pre-op care only | $12.88 | $18.62 | $18.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $131.83 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $91.20 | $131.83 | $131.83 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $64.57 Median $93.33 Typical High $93.33 | Professional | 52 · Reduced service | $64.57 | $93.33 | $93.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $37.15 Typical High $37.15 | Professional | 53 · Discontinued | $25.70 | $37.15 | $37.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $141.25 Typical High $141.25 | Professional | 54 · Surgery only | $97.72 | $141.25 | $141.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $28.18 Typical High $28.18 | Professional | 55 · Aftercare only | $19.50 | $28.18 | $28.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $18.62 Typical High $18.62 | Professional | 56 · Pre-op care only | $12.88 | $18.62 | $18.62 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $131.83 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $91.20 | $131.83 | $131.83 |
Where Maine sits
The same service costs 9.9 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 $4,605MT $466
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.