How much rates vary
Facilitymedian $182 · 10th to 90th $91 to $617Professionalmedian $170 · 10th to 90th $93 to $302
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 $91.20 Median $91.20 Typical High $141.25 | Facility | None | $91.20 | $91.20 | $141.25 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $141.25 Typical High $257.04 | Professional | None | $91.20 | $141.25 | $257.04 |
Anthem BCBS Setting Professional Modifier None Typical Low $102.33 Median $165.96 Typical High $302.00 | Professional | None | $102.33 | $165.96 | $302.00 |
Cigna Setting Facility Modifier None Typical Low $117.49 Median $263.03 Typical High $1,412.54 | Facility | None | $117.49 | $263.03 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $141.25 Median $229.09 Typical High $309.03 | Professional | None | $141.25 | $229.09 | $309.03 |
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 $128.82 Median $204.17 Typical High $302.00 | Professional | None | $128.82 | $204.17 | $302.00 |
Martin's Point Setting Professional Modifier None Typical Low $91.20 Median $141.25 Typical High $257.04 | Professional | None | $91.20 | $141.25 | $257.04 |
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 $147.91 Median $223.87 Typical High $323.59 | Professional | None | $147.91 | $223.87 | $323.59 |
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 $45.71 Median $64.57 Typical High $70.79 | Professional | 52 · Reduced service | $45.71 | $64.57 | $70.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.62 Median $25.70 Typical High $28.18 | Professional | 53 · Discontinued | $18.62 | $25.70 | $28.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $97.72 Typical High $107.15 | Professional | 54 · Surgery only | $69.18 | $97.72 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.80 Median $19.50 Typical High $21.38 | Professional | 55 · Aftercare only | $13.80 | $19.50 | $21.38 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $12.88 Typical High $14.13 | Professional | 56 · Pre-op care only | $9.12 | $12.88 | $14.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $64.57 Median $91.20 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $64.57 | $91.20 | $100.00 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $45.71 Median $45.71 Typical High $70.79 | Professional | 52 · Reduced service | $45.71 | $45.71 | $70.79 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $18.62 Median $18.62 Typical High $28.18 | Professional | 53 · Discontinued | $18.62 | $18.62 | $28.18 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $69.18 Median $69.18 Typical High $107.15 | Professional | 54 · Surgery only | $69.18 | $69.18 | $107.15 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $13.80 Median $13.80 Typical High $21.38 | Professional | 55 · Aftercare only | $13.80 | $13.80 | $21.38 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $9.12 Typical High $14.13 | Professional | 56 · Pre-op care only | $9.12 | $9.12 | $14.13 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $64.57 Median $64.57 Typical High $100.00 | Professional | 78 · Unplanned return to OR | $64.57 | $64.57 | $100.00 |
Where Maine sits
The same service costs 3.2 times more in Alaska than in Texas. 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· 35th of 51
$170
AK $427TX $132
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.