How much rates vary
Facilitymedian $501 · 10th to 90th $151 to $708Professionalmedian $363 · 10th to 90th $263 to $537
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 $269.15 Median $363.08 Typical High $537.03 | Professional | None | $269.15 | $363.08 | $537.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $269.15 Median $346.74 Typical High $512.86 | Professional | None | $269.15 | $346.74 | $512.86 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $218.78 Typical High $707.95 | Facility | None | $56.23 | $218.78 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $302.00 Median $407.38 Typical High $602.56 | Professional | None | $302.00 | $407.38 | $602.56 |
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 $257.04 Median $380.19 Typical High $630.96 | Professional | None | $257.04 | $380.19 | $630.96 |
Martin's Point Setting Professional Modifier None Typical Low $275.42 Median $363.08 Typical High $537.03 | Professional | None | $275.42 | $363.08 | $537.03 |
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 $245.47 Median $338.84 Typical High $457.09 | Professional | None | $245.47 | $338.84 | $457.09 |
13 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 $141.25 Median $162.18 Typical High $181.97 | Professional | 52 · Reduced service | $141.25 | $162.18 | $181.97 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $64.57 Typical High $72.44 | Professional | 53 · Discontinued | $56.23 | $64.57 | $72.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $213.80 Median $239.88 Typical High $269.15 | Professional | 54 · Surgery only | $213.80 | $239.88 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $42.66 Median $48.98 Typical High $53.70 | Professional | 55 · Aftercare only | $42.66 | $48.98 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $32.36 Typical High $36.31 | Professional | 56 · Pre-op care only | $28.18 | $32.36 | $36.31 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $199.53 Median $223.87 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $199.53 | $223.87 | $251.19 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $398.11 Median $524.81 Typical High $776.25 | Professional | 50 · Both sides | $398.11 | $524.81 | $776.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $158.49 Median $162.18 Typical High $181.97 | Professional | 52 · Reduced service | $158.49 | $162.18 | $181.97 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $63.10 Median $64.57 Typical High $72.44 | Professional | 53 · Discontinued | $63.10 | $64.57 | $72.44 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $239.88 Median $239.88 Typical High $269.15 | Professional | 54 · Surgery only | $239.88 | $239.88 | $269.15 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $47.86 Median $48.98 Typical High $53.70 | Professional | 55 · Aftercare only | $47.86 | $48.98 | $53.70 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $31.62 Median $32.36 Typical High $36.31 | Professional | 56 · Pre-op care only | $31.62 | $32.36 | $36.31 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $223.87 Median $223.87 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $223.87 | $223.87 | $251.19 |
Where Maine sits
The same service costs 5.4 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· 21st of 51
$363
AK $1,096TX $204
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.