How much rates vary
Facilitymedian $1,259 · 10th to 90th $537 to $1,585Professionalmedian $245 · 10th to 90th $158 to $389
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 $165.96 Median $213.80 Typical High $331.13 | Professional | None | $165.96 | $213.80 | $331.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $151.36 Median $218.78 Typical High $302.00 | Professional | None | $151.36 | $218.78 | $302.00 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,000.00 Typical High $1,412.54 | Facility | None | $537.03 | $1,000.00 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $302.00 Typical High $398.11 | Professional | None | $204.17 | $302.00 | $398.11 |
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 $177.83 Median $275.42 Typical High $512.86 | Professional | None | $177.83 | $275.42 | $512.86 |
Martin's Point Setting Professional Modifier None Typical Low $165.96 Median $213.80 Typical High $331.13 | Professional | None | $165.96 | $213.80 | $331.13 |
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 $158.49 Median $251.19 Typical High $436.52 | Professional | None | $158.49 | $251.19 | $436.52 |
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 $97.72 Median $97.72 Typical High $165.96 | Professional | 52 · Reduced service | $97.72 | $97.72 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $39.81 Typical High $67.61 | Professional | 53 · Discontinued | $39.81 | $39.81 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $147.91 Typical High $251.19 | Professional | 54 · Surgery only | $147.91 | $147.91 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $29.51 Typical High $50.12 | Professional | 55 · Aftercare only | $29.51 | $29.51 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $19.95 Typical High $33.11 | Professional | 56 · Pre-op care only | $19.95 | $19.95 | $33.11 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $138.04 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $138.04 | $138.04 | $234.42 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $97.72 Median $97.72 Typical High $165.96 | Professional | 52 · Reduced service | $97.72 | $97.72 | $165.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $39.81 Typical High $67.61 | Professional | 53 · Discontinued | $39.81 | $39.81 | $67.61 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $147.91 Typical High $251.19 | Professional | 54 · Surgery only | $147.91 | $147.91 | $251.19 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $29.51 Typical High $50.12 | Professional | 55 · Aftercare only | $29.51 | $29.51 | $50.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $19.95 Typical High $33.11 | Professional | 56 · Pre-op care only | $19.95 | $19.95 | $33.11 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $138.04 Median $138.04 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $138.04 | $138.04 | $234.42 |
Where Maine sits
The same service costs 4.5 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· 34th of 51
$251
AK $759KY $170
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.