How much rates vary
Facilitymedian $1,000 · 10th to 90th $186 to $1,585Professionalmedian $251 · 10th to 90th $166 to $447
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 Facility Modifier None Typical Low $141.25 Median $186.21 Typical High $302.00 | Facility | None | $141.25 | $186.21 | $302.00 |
Aetna Setting Professional Modifier None Typical Low $141.25 Median $186.21 Typical High $331.13 | Professional | None | $141.25 | $186.21 | $331.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $173.78 Median $251.19 Typical High $446.68 | Professional | None | $173.78 | $251.19 | $446.68 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $954.99 Typical High $1,862.09 | Facility | None | $707.95 | $954.99 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $199.53 Median $269.15 Typical High $524.81 | Professional | None | $199.53 | $269.15 | $524.81 |
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 $204.17 Median $302.00 Typical High $467.74 | Professional | None | $204.17 | $302.00 | $467.74 |
Martin's Point Setting Facility Modifier None Typical Low $141.25 Median $186.21 Typical High $302.00 | Facility | None | $141.25 | $186.21 | $302.00 |
Martin's Point Setting Professional Modifier None Typical Low $141.25 Median $186.21 Typical High $338.84 | Professional | None | $141.25 | $186.21 | $338.84 |
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 $223.87 Median $302.00 Typical High $416.87 | Professional | None | $223.87 | $302.00 | $416.87 |
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 $70.79 Median $87.10 Typical High $93.33 | Professional | 52 · Reduced service | $70.79 | $87.10 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $34.67 Typical High $38.02 | Professional | 53 · Discontinued | $28.18 | $34.67 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $131.83 Typical High $141.25 | Professional | 54 · Surgery only | $107.15 | $131.83 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $26.30 Typical High $28.18 | Professional | 55 · Aftercare only | $21.38 | $26.30 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $17.38 Typical High $18.62 | Professional | 56 · Pre-op care only | $14.13 | $17.38 | $18.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $123.03 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $100.00 | $123.03 | $131.83 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $70.79 Median $93.33 Typical High $93.33 | Professional | 52 · Reduced service | $70.79 | $93.33 | $93.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $37.15 Typical High $38.02 | Professional | 53 · Discontinued | $28.18 | $37.15 | $38.02 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $141.25 Typical High $141.25 | Professional | 54 · Surgery only | $107.15 | $141.25 | $141.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $28.18 Typical High $28.18 | Professional | 55 · Aftercare only | $21.38 | $28.18 | $28.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $18.62 Typical High $18.62 | Professional | 56 · Pre-op care only | $14.13 | $18.62 | $18.62 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $131.83 Typical High $131.83 | Professional | 78 · Unplanned return to OR | $100.00 | $131.83 | $131.83 |
Where Maine sits
The same service costs 4.7 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· 26th of 51
$251
AK $871KY $186
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.