How much rates vary
Facilitymedian $1,202 · 10th to 90th $135 to $1,413Professionalmedian $166 · 10th to 90th $123 to $275
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 $128.82 Median $173.78 Typical High $208.93 | Professional | None | $128.82 | $173.78 | $208.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $112.20 Median $165.96 Typical High $275.42 | Professional | None | $112.20 | $165.96 | $275.42 |
Cigna Setting Facility Modifier None Typical Low $114.82 Median $257.04 Typical High $1,412.54 | Facility | None | $114.82 | $257.04 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $144.54 Median $194.98 Typical High $281.84 | Professional | None | $144.54 | $194.98 | $281.84 |
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 $123.03 Median $186.21 Typical High $288.40 | Professional | None | $123.03 | $186.21 | $288.40 |
Martin's Point Setting Professional Modifier None Typical Low $128.82 Median $173.78 Typical High $204.17 | Professional | None | $128.82 | $173.78 | $204.17 |
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 $109.65 Median $165.96 Typical High $263.03 | Professional | None | $109.65 | $165.96 | $263.03 |
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 $64.57 Median $70.79 Typical High $89.13 | Professional | 52 · Reduced service | $64.57 | $70.79 | $89.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $28.18 Typical High $35.48 | Professional | 53 · Discontinued | $25.70 | $28.18 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $107.15 Typical High $134.90 | Professional | 54 · Surgery only | $97.72 | $107.15 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $21.38 Typical High $26.92 | Professional | 55 · Aftercare only | $19.50 | $21.38 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $14.13 Typical High $17.78 | Professional | 56 · Pre-op care only | $12.88 | $14.13 | $17.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $100.00 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $91.20 | $100.00 | $125.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $64.57 Median $70.79 Typical High $89.13 | Professional | 52 · Reduced service | $64.57 | $70.79 | $89.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $28.18 Typical High $35.48 | Professional | 53 · Discontinued | $26.30 | $28.18 | $35.48 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $107.15 Typical High $134.90 | Professional | 54 · Surgery only | $97.72 | $107.15 | $134.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $21.38 Typical High $26.92 | Professional | 55 · Aftercare only | $19.50 | $21.38 | $26.92 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $14.13 Typical High $17.78 | Professional | 56 · Pre-op care only | $12.88 | $14.13 | $17.78 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $100.00 Typical High $125.89 | Professional | 78 · Unplanned return to OR | $91.20 | $100.00 | $125.89 |
Where Maine sits
The same service costs 4.0 times more in Alaska than in New Jersey. 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· 25th of 51
$170
AK $437NJ $110
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.