How much rates vary
Facilitymedian $525 · 10th to 90th $282 to $708Professionalmedian $389 · 10th to 90th $257 to $661
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 $218.78 Median $275.42 Typical High $501.19 | Professional | None | $218.78 | $275.42 | $501.19 |
Anthem BCBS Setting Professional Modifier None Typical Low $257.04 Median $380.19 Typical High $660.69 | Professional | None | $257.04 | $380.19 | $660.69 |
Cigna Setting Facility Modifier None Typical Low $239.88 Median $457.09 Typical High $1,412.54 | Facility | None | $239.88 | $457.09 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $309.03 Median $398.11 Typical High $776.25 | Professional | None | $309.03 | $398.11 | $776.25 |
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 $331.13 Median $457.09 Typical High $660.69 | Professional | None | $331.13 | $457.09 | $660.69 |
Martin's Point Setting Professional Modifier None Typical Low $218.78 Median $275.42 Typical High $602.56 | Professional | None | $218.78 | $275.42 | $602.56 |
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 $338.84 Median $457.09 Typical High $630.96 | Professional | None | $338.84 | $457.09 | $630.96 |
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 $109.65 Median $134.90 Typical High $138.04 | Professional | 52 · Reduced service | $109.65 | $134.90 | $138.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $53.70 Typical High $54.95 | Professional | 53 · Discontinued | $43.65 | $53.70 | $54.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $165.96 Median $199.53 Typical High $204.17 | Professional | 54 · Surgery only | $165.96 | $199.53 | $204.17 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.11 Median $39.81 Typical High $40.74 | Professional | 55 · Aftercare only | $33.11 | $39.81 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $26.92 Typical High $27.54 | Professional | 56 · Pre-op care only | $21.88 | $26.92 | $27.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $154.88 Median $186.21 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $154.88 | $186.21 | $190.55 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $109.65 Median $138.04 Typical High $138.04 | Professional | 52 · Reduced service | $109.65 | $138.04 | $138.04 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $54.95 Typical High $54.95 | Professional | 53 · Discontinued | $43.65 | $54.95 | $54.95 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $165.96 Median $204.17 Typical High $204.17 | Professional | 54 · Surgery only | $165.96 | $204.17 | $204.17 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $33.11 Median $40.74 Typical High $40.74 | Professional | 55 · Aftercare only | $33.11 | $40.74 | $40.74 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $27.54 Typical High $27.54 | Professional | 56 · Pre-op care only | $21.88 | $27.54 | $27.54 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $154.88 Median $190.55 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $154.88 | $190.55 | $190.55 |
Where Maine sits
The same service costs 4.7 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· 23rd of 51
$389
AK $1,122TX $240
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.