How much rates vary
Facilitymedian $525 · 10th to 90th $339 to $708Professionalmedian $195 · 10th to 90th $112 to $347
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 $100.00 Median $154.88 Typical High $269.15 | Professional | None | $100.00 | $154.88 | $269.15 |
Anthem BCBS Setting Professional Modifier None Typical Low $117.49 Median $194.98 Typical High $316.23 | Professional | None | $117.49 | $194.98 | $316.23 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $218.78 Typical High $371.54 | Professional | None | $134.90 | $218.78 | $371.54 |
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 $138.04 Median $234.42 Typical High $363.08 | Professional | None | $138.04 | $234.42 | $363.08 |
Martin's Point Setting Professional Modifier None Typical Low $100.00 Median $154.88 Typical High $295.12 | Professional | None | $100.00 | $154.88 | $295.12 |
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 $158.49 Median $234.42 Typical High $338.84 | Professional | None | $158.49 | $234.42 | $338.84 |
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 $50.12 Median $63.10 Typical High $77.62 | Professional | 52 · Reduced service | $50.12 | $63.10 | $77.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $25.12 Typical High $30.90 | Professional | 53 · Discontinued | $19.95 | $25.12 | $30.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $93.33 Typical High $114.82 | Professional | 54 · Surgery only | $74.13 | $93.33 | $114.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $18.62 Typical High $22.91 | Professional | 55 · Aftercare only | $14.79 | $18.62 | $22.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $12.59 Typical High $15.49 | Professional | 56 · Pre-op care only | $10.00 | $12.59 | $15.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $87.10 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $69.18 | $87.10 | $107.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $50.12 Median $63.10 Typical High $77.62 | Professional | 52 · Reduced service | $50.12 | $63.10 | $77.62 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $25.12 Typical High $30.90 | Professional | 53 · Discontinued | $19.95 | $25.12 | $30.90 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $93.33 Typical High $114.82 | Professional | 54 · Surgery only | $74.13 | $93.33 | $114.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $18.62 Typical High $22.91 | Professional | 55 · Aftercare only | $14.79 | $18.62 | $22.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $12.59 Typical High $15.49 | Professional | 56 · Pre-op care only | $10.00 | $12.59 | $15.49 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $87.10 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $69.18 | $87.10 | $107.15 |
Where Maine sits
The same service costs 3.3 times more in Alaska than in Maryland. 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· 24th of 51
$195
AK $490MD $148
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.