How much rates vary
Facilitymedian $525 · 10th to 90th $257 to $708Professionalmedian $355 · 10th to 90th $229 to $550
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 $257.04 Median $257.04 Typical High $363.08 | Professional | None | $257.04 | $257.04 | $363.08 |
Anthem BCBS Setting Professional Modifier None Typical Low $194.98 Median $331.13 Typical High $549.54 | Professional | None | $194.98 | $331.13 | $549.54 |
Cigna Setting Facility Modifier None Typical Low $218.78 Median $501.19 Typical High $1,862.09 | Facility | None | $218.78 | $501.19 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $257.04 Median $380.19 Typical High $562.34 | Professional | None | $257.04 | $380.19 | $562.34 |
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 $234.42 Median $363.08 Typical High $575.44 | Professional | None | $234.42 | $363.08 | $575.44 |
Martin's Point Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $363.08 | Professional | None | $257.04 | $257.04 | $363.08 |
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 $288.40 Median $398.11 Typical High $630.96 | Professional | None | $288.40 | $398.11 | $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 $125.89 Median $125.89 Typical High $181.97 | Professional | 52 · Reduced service | $125.89 | $125.89 | $181.97 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $51.29 Median $51.29 Typical High $72.44 | Professional | 53 · Discontinued | $51.29 | $51.29 | $72.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $190.55 Typical High $269.15 | Professional | 54 · Surgery only | $190.55 | $190.55 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $38.02 Typical High $53.70 | Professional | 55 · Aftercare only | $38.02 | $38.02 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $25.70 Typical High $36.31 | Professional | 56 · Pre-op care only | $25.70 | $25.70 | $36.31 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $177.83 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $177.83 | $177.83 | $251.19 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $125.89 Median $125.89 Typical High $181.97 | Professional | 52 · Reduced service | $125.89 | $125.89 | $181.97 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $51.29 Median $51.29 Typical High $72.44 | Professional | 53 · Discontinued | $51.29 | $51.29 | $72.44 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $190.55 Typical High $269.15 | Professional | 54 · Surgery only | $190.55 | $190.55 | $269.15 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $38.02 Typical High $53.70 | Professional | 55 · Aftercare only | $38.02 | $38.02 | $53.70 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $25.70 Typical High $36.31 | Professional | 56 · Pre-op care only | $25.70 | $25.70 | $36.31 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $177.83 Median $177.83 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $177.83 | $177.83 | $251.19 |
Where Maine sits
The same service costs 3.7 times more in Wisconsin 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· 20th of 51
$363
WI $891TX $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.