How much rates vary
Facilitymedian $1,202 · 10th to 90th $275 to $1,413Professionalmedian $288 · 10th to 90th $191 to $479
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 $186.21 Median $263.03 Typical High $316.23 | Professional | None | $186.21 | $263.03 | $316.23 |
Anthem BCBS Setting Professional Modifier None Typical Low $158.49 Median $281.84 Typical High $489.78 | Professional | None | $158.49 | $281.84 | $489.78 |
Cigna Setting Facility Modifier None Typical Low $234.42 Median $457.09 Typical High $1,412.54 | Facility | None | $234.42 | $457.09 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $223.87 Median $338.84 Typical High $501.19 | Professional | None | $223.87 | $338.84 | $501.19 |
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 $190.55 Median $309.03 Typical High $478.63 | Professional | None | $190.55 | $309.03 | $478.63 |
Martin's Point Setting Professional Modifier None Typical Low $186.21 Median $263.03 Typical High $316.23 | Professional | None | $186.21 | $263.03 | $316.23 |
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 $229.09 Median $323.59 Typical High $446.68 | Professional | None | $229.09 | $323.59 | $446.68 |
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 $102.33 Median $102.33 Typical High $158.49 | Professional | 52 · Reduced service | $102.33 | $102.33 | $158.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $40.74 Typical High $63.10 | Professional | 53 · Discontinued | $40.74 | $40.74 | $63.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $151.36 Median $151.36 Typical High $239.88 | Professional | 54 · Surgery only | $151.36 | $151.36 | $239.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $30.90 Typical High $47.86 | Professional | 55 · Aftercare only | $30.90 | $30.90 | $47.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $20.42 Typical High $31.62 | Professional | 56 · Pre-op care only | $20.42 | $20.42 | $31.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $141.25 Median $141.25 Typical High $223.87 | Professional | 78 · Unplanned return to OR | $141.25 | $141.25 | $223.87 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $102.33 Median $102.33 Typical High $158.49 | Professional | 52 · Reduced service | $102.33 | $102.33 | $158.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $40.74 Typical High $63.10 | Professional | 53 · Discontinued | $40.74 | $40.74 | $63.10 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $151.36 Median $151.36 Typical High $239.88 | Professional | 54 · Surgery only | $151.36 | $151.36 | $239.88 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $30.90 Typical High $47.86 | Professional | 55 · Aftercare only | $30.90 | $30.90 | $47.86 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $20.42 Typical High $31.62 | Professional | 56 · Pre-op care only | $20.42 | $20.42 | $31.62 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $141.25 Median $141.25 Typical High $223.87 | Professional | 78 · Unplanned return to OR | $141.25 | $141.25 | $223.87 |
Where Maine sits
The same service costs 4.3 times more in Wisconsin 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· 30th of 51
$288
WI $794KY $186
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.