How much rates vary
Facilitymedian $501 · 10th to 90th $141 to $708Professionalmedian $191 · 10th to 90th $120 to $309
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 $165.96 Typical High $218.78 | Professional | None | $128.82 | $165.96 | $218.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $123.03 Median $190.55 Typical High $323.59 | Professional | None | $123.03 | $190.55 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $204.17 Typical High $707.95 | Facility | None | $56.23 | $204.17 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $144.54 Median $218.78 Typical High $323.59 | Professional | None | $144.54 | $218.78 | $323.59 |
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 $120.23 Median $190.55 Typical High $354.81 | Professional | None | $120.23 | $190.55 | $354.81 |
Martin's Point Setting Professional Modifier None Typical Low $131.83 Median $165.96 Typical High $218.78 | Professional | None | $131.83 | $165.96 | $218.78 |
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 $112.20 Median $181.97 Typical High $302.00 | Professional | None | $112.20 | $181.97 | $302.00 |
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 $81.28 Typical High $107.15 | Professional | 52 · Reduced service | $64.57 | $81.28 | $107.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $33.11 Typical High $43.65 | Professional | 53 · Discontinued | $25.70 | $33.11 | $43.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $123.03 Typical High $162.18 | Professional | 54 · Surgery only | $97.72 | $123.03 | $162.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $24.55 Typical High $32.36 | Professional | 55 · Aftercare only | $19.50 | $24.55 | $32.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $16.60 Typical High $21.88 | Professional | 56 · Pre-op care only | $12.88 | $16.60 | $21.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $91.20 Median $114.82 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $91.20 | $114.82 | $151.36 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $66.07 Median $81.28 Typical High $107.15 | Professional | 52 · Reduced service | $66.07 | $81.28 | $107.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $33.11 Typical High $43.65 | Professional | 53 · Discontinued | $26.30 | $33.11 | $43.65 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $123.03 Typical High $162.18 | Professional | 54 · Surgery only | $100.00 | $123.03 | $162.18 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $24.55 Typical High $32.36 | Professional | 55 · Aftercare only | $19.95 | $24.55 | $32.36 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $16.60 Typical High $21.88 | Professional | 56 · Pre-op care only | $13.18 | $16.60 | $21.88 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $93.33 Median $114.82 Typical High $151.36 | Professional | 78 · Unplanned return to OR | $93.33 | $114.82 | $151.36 |
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· 21st of 51
$191
AK $437NJ $126
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.