How much rates vary
Facilitymedian $525 · 10th to 90th $339 to $708Professionalmedian $158 · 10th to 90th $105 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 $104.71 Median $134.90 Typical High $169.82 | Professional | None | $104.71 | $134.90 | $169.82 |
Anthem BCBS Setting Professional Modifier None Typical Low $104.71 Median $154.88 Typical High $275.42 | Professional | None | $104.71 | $154.88 | $275.42 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
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 $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 $181.97 Typical High $275.42 | Professional | None | $120.23 | $181.97 | $275.42 |
Martin's Point Setting Professional Modifier None Typical Low $104.71 Median $134.90 Typical High $165.96 | Professional | None | $104.71 | $134.90 | $165.96 |
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 $131.83 Median $177.83 Typical High $245.47 | Professional | None | $131.83 | $177.83 | $245.47 |
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 $52.48 Median $67.61 Typical High $67.61 | Professional | 52 · Reduced service | $52.48 | $67.61 | $67.61 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $26.92 Typical High $26.92 | Professional | 53 · Discontinued | $20.89 | $26.92 | $26.92 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $100.00 Typical High $100.00 | Professional | 54 · Surgery only | $77.62 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $19.95 Typical High $19.95 | Professional | 55 · Aftercare only | $15.49 | $19.95 | $19.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $13.49 Typical High $13.49 | Professional | 56 · Pre-op care only | $10.47 | $13.49 | $13.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $72.44 Median $93.33 Typical High $93.33 | Professional | 78 · Unplanned return to OR | $72.44 | $93.33 | $93.33 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $52.48 Median $67.61 Typical High $67.61 | Professional | 52 · Reduced service | $52.48 | $67.61 | $67.61 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $26.92 Typical High $26.92 | Professional | 53 · Discontinued | $20.89 | $26.92 | $26.92 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $100.00 Typical High $100.00 | Professional | 54 · Surgery only | $77.62 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $19.95 Typical High $19.95 | Professional | 55 · Aftercare only | $15.49 | $19.95 | $19.95 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $13.49 Typical High $13.49 | Professional | 56 · Pre-op care only | $10.47 | $13.49 | $13.49 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $72.44 Median $93.33 Typical High $93.33 | Professional | 78 · Unplanned return to OR | $72.44 | $93.33 | $93.33 |
Where Maine sits
The same service costs 4.2 times more in Alaska 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· 29th of 51
$162
AK $437KY $105
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.