How much rates vary
Facilitymedian $1,202 · 10th to 90th $224 to $1,413Professionalmedian $251 · 10th to 90th $158 to $407
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 $173.78 Median $218.78 Typical High $281.84 | Professional | None | $173.78 | $218.78 | $281.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $162.18 Median $251.19 Typical High $416.87 | Professional | None | $162.18 | $251.19 | $416.87 |
Cigna Setting Facility Modifier None Typical Low $190.55 Median $426.58 Typical High $1,412.54 | Facility | None | $190.55 | $426.58 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $186.21 Median $295.12 Typical High $436.52 | Professional | None | $186.21 | $295.12 | $436.52 |
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 $158.49 Median $251.19 Typical High $446.68 | Professional | None | $158.49 | $251.19 | $446.68 |
Martin's Point Setting Professional Modifier None Typical Low $173.78 Median $218.78 Typical High $281.84 | Professional | None | $173.78 | $218.78 | $281.84 |
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 $147.91 Median $239.88 Typical High $416.87 | Professional | None | $147.91 | $239.88 | $416.87 |
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 $87.10 Median $107.15 Typical High $141.25 | Professional | 52 · Reduced service | $87.10 | $107.15 | $141.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $42.66 Typical High $57.54 | Professional | 53 · Discontinued | $34.67 | $42.66 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $162.18 Typical High $213.80 | Professional | 54 · Surgery only | $128.82 | $162.18 | $213.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $32.36 Typical High $42.66 | Professional | 55 · Aftercare only | $25.70 | $32.36 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $21.38 Typical High $28.18 | Professional | 56 · Pre-op care only | $17.38 | $21.38 | $28.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $151.36 Typical High $199.53 | Professional | 78 · Unplanned return to OR | $120.23 | $151.36 | $199.53 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $87.10 Median $107.15 Typical High $141.25 | Professional | 52 · Reduced service | $87.10 | $107.15 | $141.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $42.66 Typical High $57.54 | Professional | 53 · Discontinued | $34.67 | $42.66 | $57.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $162.18 Typical High $213.80 | Professional | 54 · Surgery only | $131.83 | $162.18 | $213.80 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $32.36 Typical High $42.66 | Professional | 55 · Aftercare only | $26.30 | $32.36 | $42.66 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $21.38 Typical High $28.18 | Professional | 56 · Pre-op care only | $17.38 | $21.38 | $28.18 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $123.03 Median $151.36 Typical High $199.53 | Professional | 78 · Unplanned return to OR | $123.03 | $151.36 | $199.53 |
Where Maine sits
The same service costs 3.5 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· 23rd of 51
$251
AK $575NJ $166
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.