How much rates vary
Facilitymedian $501 · 10th to 90th $102 to $708Professionalmedian $155 · 10th to 90th $117 to $240
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 Facility Modifier None Typical Low $151.36 Median $151.36 Typical High $154.88 | Facility | None | $151.36 | $151.36 | $154.88 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $151.36 Typical High $158.49 | Professional | None | $120.23 | $151.36 | $158.49 |
Anthem BCBS Setting Professional Modifier None Typical Low $123.03 Median $158.49 Typical High $239.88 | Professional | None | $123.03 | $158.49 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $144.54 Typical High $707.95 | Facility | None | $56.23 | $144.54 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $131.83 Median $169.82 Typical High $245.47 | Professional | None | $131.83 | $169.82 | $245.47 |
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 $117.49 Median $162.18 Typical High $251.19 | Professional | None | $117.49 | $162.18 | $251.19 |
Martin's Point Setting Professional Modifier None Typical Low $120.23 Median $151.36 Typical High $158.49 | Professional | None | $120.23 | $151.36 | $158.49 |
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 $107.15 Median $154.88 Typical High $208.93 | Professional | None | $107.15 | $154.88 | $208.93 |
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 $70.79 Median $75.86 Typical High $77.62 | Professional | 52 · Reduced service | $70.79 | $75.86 | $77.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $30.20 Typical High $30.90 | Professional | 53 · Discontinued | $28.18 | $30.20 | $30.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $104.71 Median $114.82 Typical High $114.82 | Professional | 54 · Surgery only | $104.71 | $114.82 | $114.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.89 Median $22.91 Typical High $23.44 | Professional | 55 · Aftercare only | $20.89 | $22.91 | $23.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $15.14 Typical High $15.49 | Professional | 56 · Pre-op care only | $14.13 | $15.14 | $15.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $97.72 Median $107.15 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $97.72 | $107.15 | $107.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $75.86 Median $75.86 Typical High $77.62 | Professional | 52 · Reduced service | $75.86 | $75.86 | $77.62 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $30.20 Typical High $30.90 | Professional | 53 · Discontinued | $30.20 | $30.20 | $30.90 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $114.82 Median $114.82 Typical High $114.82 | Professional | 54 · Surgery only | $114.82 | $114.82 | $114.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $22.91 Median $22.91 Typical High $23.44 | Professional | 55 · Aftercare only | $22.91 | $22.91 | $23.44 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $15.14 Typical High $15.49 | Professional | 56 · Pre-op care only | $15.14 | $15.14 | $15.49 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $107.15 Median $107.15 Typical High $107.15 | Professional | 78 · Unplanned return to OR | $107.15 | $107.15 | $107.15 |
Where Maine sits
The same service costs 5.1 times more in Alaska than in Utah. 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· 26th of 51
$155
AK $501UT $97.72
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.