How much rates vary
Facilitymedian $933 · 10th to 90th $209 to $1,380Professionalmedian $302 · 10th to 90th $174 to $550
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 $173.78 Median $186.21 Typical High $269.15 | Professional | None | $173.78 | $186.21 | $269.15 |
Anthem BCBS Setting Professional Modifier None Typical Low $186.21 Median $302.00 Typical High $549.54 | Professional | None | $186.21 | $302.00 | $549.54 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $309.03 Typical High $707.95 | Facility | None | $56.23 | $309.03 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $257.04 Median $389.05 Typical High $562.34 | Professional | None | $257.04 | $389.05 | $562.34 |
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 $229.09 Median $363.08 Typical High $562.34 | Professional | None | $229.09 | $363.08 | $562.34 |
Martin's Point Setting Professional Modifier None Typical Low $173.78 Median $186.21 Typical High $269.15 | Professional | None | $173.78 | $186.21 | $269.15 |
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 $239.88 Median $363.08 Typical High $501.19 | Professional | None | $239.88 | $363.08 | $501.19 |
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 $87.10 Median $87.10 Typical High $134.90 | Professional | 52 · Reduced service | $87.10 | $87.10 | $134.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $34.67 Typical High $53.70 | Professional | 53 · Discontinued | $34.67 | $34.67 | $53.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $128.82 Typical High $199.53 | Professional | 54 · Surgery only | $128.82 | $128.82 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $25.70 Typical High $39.81 | Professional | 55 · Aftercare only | $25.70 | $25.70 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $17.38 Typical High $26.92 | Professional | 56 · Pre-op care only | $17.38 | $17.38 | $26.92 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $120.23 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $120.23 | $120.23 | $186.21 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $87.10 Median $87.10 Typical High $134.90 | Professional | 52 · Reduced service | $87.10 | $87.10 | $134.90 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $34.67 Typical High $53.70 | Professional | 53 · Discontinued | $34.67 | $34.67 | $53.70 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $128.82 Typical High $199.53 | Professional | 54 · Surgery only | $128.82 | $128.82 | $199.53 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $25.70 Typical High $39.81 | Professional | 55 · Aftercare only | $25.70 | $25.70 | $39.81 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $17.38 Typical High $26.92 | Professional | 56 · Pre-op care only | $17.38 | $17.38 | $26.92 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $120.23 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $120.23 | $120.23 | $186.21 |
Where Maine sits
The same service costs 3.5 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· 27th of 51
$302
AK $759TX $214
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.