How much rates vary
Facilitymedian $708 · 10th to 90th $195 to $1,202Professionalmedian $245 · 10th to 90th $158 to $437
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 $141.25 Median $181.97 Typical High $380.19 | Professional | None | $141.25 | $181.97 | $380.19 |
Anthem BCBS Setting Professional Modifier None Typical Low $173.78 Median $245.47 Typical High $436.52 | Professional | None | $173.78 | $245.47 | $436.52 |
Cigna Setting Facility Modifier None Typical Low $165.96 Median $380.19 Typical High $1,412.54 | Facility | None | $165.96 | $380.19 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $199.53 Median $257.04 Typical High $512.86 | Professional | None | $199.53 | $257.04 | $512.86 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $194.98 Median $295.12 Typical High $446.68 | Professional | None | $194.98 | $295.12 | $446.68 |
Martin's Point Setting Professional Modifier None Typical Low $141.25 Median $181.97 Typical High $380.19 | Professional | None | $141.25 | $181.97 | $380.19 |
United Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
United Setting Professional Modifier None Typical Low $218.78 Median $302.00 Typical High $416.87 | Professional | None | $218.78 | $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 $85.11 Typical High $91.20 | Professional | 52 · Reduced service | $70.79 | $85.11 | $91.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $33.88 Typical High $36.31 | Professional | 53 · Discontinued | $28.18 | $33.88 | $36.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $125.89 Typical High $134.90 | Professional | 54 · Surgery only | $107.15 | $125.89 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $25.12 Typical High $26.92 | Professional | 55 · Aftercare only | $21.38 | $25.12 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $16.98 Typical High $18.20 | Professional | 56 · Pre-op care only | $14.13 | $16.98 | $18.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $117.49 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $100.00 | $117.49 | $125.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $70.79 Median $91.20 Typical High $91.20 | Professional | 52 · Reduced service | $70.79 | $91.20 | $91.20 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $36.31 Typical High $36.31 | Professional | 53 · Discontinued | $28.18 | $36.31 | $36.31 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $134.90 Typical High $134.90 | Professional | 54 · Surgery only | $107.15 | $134.90 | $134.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $26.92 Typical High $26.92 | Professional | 55 · Aftercare only | $21.38 | $26.92 | $26.92 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $18.20 Typical High $18.20 | Professional | 56 · Pre-op care only | $14.13 | $18.20 | $18.20 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $100.00 Median $125.89 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $100.00 | $125.89 | $125.89 |
Where Maine sits
The same service costs 3.9 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
$257
AK $724KY $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.