How much rates vary
Facilitymedian $708 · 10th to 90th $186 to $1,202Professionalmedian $200 · 10th to 90th $112 to $380
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 $97.72 Median $158.49 Typical High $239.88 | Professional | None | $97.72 | $158.49 | $239.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $125.89 Median $199.53 Typical High $371.54 | Professional | None | $125.89 | $199.53 | $371.54 |
Cigna Setting Facility Modifier None Typical Low $158.49 Median $363.08 Typical High $1,412.54 | Facility | None | $158.49 | $363.08 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $229.09 Typical High $380.19 | Professional | None | $138.04 | $229.09 | $380.19 |
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 $138.04 Median $239.88 Typical High $380.19 | Professional | None | $138.04 | $239.88 | $380.19 |
Martin's Point Setting Professional Modifier None Typical Low $97.72 Median $158.49 Typical High $239.88 | Professional | None | $97.72 | $158.49 | $239.88 |
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 $158.49 Median $239.88 Typical High $346.74 | Professional | None | $158.49 | $239.88 | $346.74 |
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 $48.98 Median $63.10 Typical High $79.43 | Professional | 52 · Reduced service | $48.98 | $63.10 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.50 Median $25.12 Typical High $31.62 | Professional | 53 · Discontinued | $19.50 | $25.12 | $31.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $95.50 Typical High $120.23 | Professional | 54 · Surgery only | $74.13 | $95.50 | $120.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $19.05 Typical High $23.99 | Professional | 55 · Aftercare only | $14.79 | $19.05 | $23.99 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.77 Median $12.59 Typical High $15.85 | Professional | 56 · Pre-op care only | $9.77 | $12.59 | $15.85 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $89.13 Typical High $112.20 | Professional | 78 · Unplanned return to OR | $69.18 | $89.13 | $112.20 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $48.98 Median $63.10 Typical High $79.43 | Professional | 52 · Reduced service | $48.98 | $63.10 | $79.43 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $19.50 Median $25.12 Typical High $31.62 | Professional | 53 · Discontinued | $19.50 | $25.12 | $31.62 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $95.50 Typical High $120.23 | Professional | 54 · Surgery only | $74.13 | $95.50 | $120.23 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $19.05 Typical High $23.99 | Professional | 55 · Aftercare only | $14.79 | $19.05 | $23.99 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $9.77 Median $12.59 Typical High $15.85 | Professional | 56 · Pre-op care only | $9.77 | $12.59 | $15.85 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $89.13 Typical High $112.20 | Professional | 78 · Unplanned return to OR | $69.18 | $89.13 | $112.20 |
Where Maine sits
The same service costs 3.6 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· 25th of 51
$200
AK $501KY $138
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.