How much rates vary
Facilitymedian $1,259 · 10th to 90th $708 to $1,862Professionalmedian $363 · 10th to 90th $214 to $646
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 $190.55 Median $269.15 Typical High $562.34 | Professional | None | $190.55 | $269.15 | $562.34 |
Anthem BCBS Setting Professional Modifier None Typical Low $239.88 Median $363.08 Typical High $630.96 | Professional | None | $239.88 | $363.08 | $630.96 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,000.00 Typical High $1,862.09 | Facility | None | $707.95 | $1,000.00 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $263.03 Median $380.19 Typical High $676.08 | Professional | None | $263.03 | $380.19 | $676.08 |
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 $251.19 Median $416.87 Typical High $660.69 | Professional | None | $251.19 | $416.87 | $660.69 |
Martin's Point Setting Professional Modifier None Typical Low $190.55 Median $269.15 Typical High $575.44 | Professional | None | $190.55 | $269.15 | $575.44 |
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 $302.00 Median $416.87 Typical High $602.56 | Professional | None | $302.00 | $416.87 | $602.56 |
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 $95.50 Median $120.23 Typical High $134.90 | Professional | 52 · Reduced service | $95.50 | $120.23 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $47.86 Typical High $53.70 | Professional | 53 · Discontinued | $38.02 | $47.86 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $181.97 Typical High $204.17 | Professional | 54 · Surgery only | $144.54 | $181.97 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $36.31 Typical High $40.74 | Professional | 55 · Aftercare only | $28.84 | $36.31 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $23.99 Typical High $26.92 | Professional | 56 · Pre-op care only | $19.05 | $23.99 | $26.92 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $169.82 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $134.90 | $169.82 | $190.55 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $95.50 Median $120.23 Typical High $134.90 | Professional | 52 · Reduced service | $95.50 | $120.23 | $134.90 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $47.86 Typical High $53.70 | Professional | 53 · Discontinued | $38.02 | $47.86 | $53.70 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $181.97 Typical High $204.17 | Professional | 54 · Surgery only | $144.54 | $181.97 | $204.17 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $36.31 Typical High $40.74 | Professional | 55 · Aftercare only | $28.84 | $36.31 | $40.74 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $23.99 Typical High $26.92 | Professional | 56 · Pre-op care only | $19.05 | $23.99 | $26.92 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $169.82 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $134.90 | $169.82 | $190.55 |
Where Maine sits
The same service costs 4.0 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
$363
AK $1,072KY $269
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.