How much rates vary
Facilitymedian $117 · 10th to 90th $81 to $708Professionalmedian $145 · 10th to 90th $85 to $240
Distribution of negotiated rates across all payers (price axis is log-scale). 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 Facility Modifier None Typical Low $81.28 Median $97.72 Typical High $158.49 | Facility | None | $81.28 | $97.72 | $158.49 |
Aetna Setting Professional Modifier None Typical Low $81.28 Median $97.72 Typical High $208.93 | Professional | None | $81.28 | $97.72 | $208.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $95.50 Median $141.25 Typical High $239.88 | Professional | None | $95.50 | $141.25 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $138.04 Typical High $707.95 | Facility | None | $56.23 | $138.04 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $186.21 Typical High $275.42 | Professional | None | $138.04 | $186.21 | $275.42 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $117.49 Median $162.18 Typical High $251.19 | Professional | None | $117.49 | $162.18 | $251.19 |
Martin's Point Setting Facility Modifier None Typical Low $81.28 Median $117.49 Typical High $14,125.38 | Facility | None | $81.28 | $117.49 | $14,125.38 |
Martin's Point Setting Professional Modifier None Typical Low $81.28 Median $97.72 Typical High $208.93 | Professional | None | $81.28 | $97.72 | $208.93 |
United Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
United Setting Professional Modifier None Typical Low $114.82 Median $162.18 Typical High $245.47 | Professional | None | $114.82 | $162.18 | $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 $40.74 Median $42.66 Typical High $48.98 | Professional | 52 · Reduced service | $40.74 | $42.66 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.22 Median $16.98 Typical High $19.50 | Professional | 53 · Discontinued | $16.22 | $16.98 | $19.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $60.26 Median $63.10 Typical High $72.44 | Professional | 54 · Surgery only | $60.26 | $63.10 | $72.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.02 Median $12.59 Typical High $14.45 | Professional | 55 · Aftercare only | $12.02 | $12.59 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $8.51 Typical High $9.77 | Professional | 56 · Pre-op care only | $8.13 | $8.51 | $9.77 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $56.23 Median $58.88 Typical High $67.61 | Professional | 78 · Unplanned return to OR | $56.23 | $58.88 | $67.61 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $40.74 Median $48.98 Typical High $48.98 | Professional | 52 · Reduced service | $40.74 | $48.98 | $48.98 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $16.22 Median $19.50 Typical High $19.50 | Professional | 53 · Discontinued | $16.22 | $19.50 | $19.50 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $60.26 Median $72.44 Typical High $72.44 | Professional | 54 · Surgery only | $60.26 | $72.44 | $72.44 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $12.02 Median $14.45 Typical High $14.45 | Professional | 55 · Aftercare only | $12.02 | $14.45 | $14.45 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $9.77 Typical High $9.77 | Professional | 56 · Pre-op care only | $8.13 | $9.77 | $9.77 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $56.23 Median $67.61 Typical High $67.61 | Professional | 78 · Unplanned return to OR | $56.23 | $67.61 | $67.61 |
Where Maine sits
The same service costs 4.4 times more in Alaska than in Kentucky. 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.
Maine· 23rd of 51
$141
AK $437KY $100
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.