How much rates vary
Facilitymedian $525 · 10th to 90th $339 to $776Professionalmedian $372 · 10th to 90th $234 to $562
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 $234.42 Median $288.40 Typical High $436.52 | Professional | None | $234.42 | $288.40 | $436.52 |
Anthem BCBS Setting Professional Modifier None Typical Low $199.53 Median $338.84 Typical High $562.34 | Professional | None | $199.53 | $338.84 | $562.34 |
Cigna Setting Facility Modifier None Typical Low $338.84 Median $537.03 Typical High $1,412.54 | Facility | None | $338.84 | $537.03 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $275.42 Median $407.38 Typical High $575.44 | Professional | None | $275.42 | $407.38 | $575.44 |
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 $239.88 Median $389.05 Typical High $602.56 | Professional | None | $239.88 | $389.05 | $602.56 |
Martin's Point Setting Professional Modifier None Typical Low $234.42 Median $288.40 Typical High $436.52 | Professional | None | $234.42 | $288.40 | $436.52 |
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 $295.12 Median $407.38 Typical High $602.56 | Professional | None | $295.12 | $407.38 | $602.56 |
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 $138.04 Median $138.04 Typical High $213.80 | Professional | 52 · Reduced service | $138.04 | $138.04 | $213.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $56.23 Typical High $87.10 | Professional | 53 · Discontinued | $56.23 | $56.23 | $87.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $208.93 Typical High $323.59 | Professional | 54 · Surgery only | $208.93 | $208.93 | $323.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $41.69 Typical High $64.57 | Professional | 55 · Aftercare only | $41.69 | $41.69 | $64.57 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $28.18 Typical High $43.65 | Professional | 56 · Pre-op care only | $28.18 | $28.18 | $43.65 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $194.98 Median $194.98 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $194.98 | $194.98 | $302.00 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $138.04 Median $138.04 Typical High $213.80 | Professional | 52 · Reduced service | $138.04 | $138.04 | $213.80 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $56.23 Typical High $87.10 | Professional | 53 · Discontinued | $56.23 | $56.23 | $87.10 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $208.93 Typical High $323.59 | Professional | 54 · Surgery only | $208.93 | $208.93 | $323.59 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $41.69 Typical High $64.57 | Professional | 55 · Aftercare only | $41.69 | $41.69 | $64.57 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $28.18 Typical High $43.65 | Professional | 56 · Pre-op care only | $28.18 | $28.18 | $43.65 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $194.98 Median $194.98 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $194.98 | $194.98 | $302.00 |
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· 24th of 51
$372
WI $933TX $251
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.