How much rates vary
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 $758.58 Median $758.58 Typical High $1,348.96 | Professional | None | $758.58 | $758.58 | $1,348.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $676.08 Median $1,071.52 Typical High $1,445.44 | Professional | None | $676.08 | $1,071.52 | $1,445.44 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,023.29 Median $1,584.89 Typical High $2,137.96 | Professional | 50 · Both sides | $1,023.29 | $1,584.89 | $2,137.96 |
Cigna Setting Facility Modifier None Typical Low $1,148.15 Median $3,388.44 Typical High $5,495.41 | Facility | None | $1,148.15 | $3,388.44 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $1,000.00 Median $1,023.29 Typical High $1,698.24 | Professional | None | $1,000.00 | $1,023.29 | $1,698.24 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $851.14 Median $1,174.90 Typical High $1,513.56 | Professional | None | $851.14 | $1,174.90 | $1,513.56 |
Martin's Point Setting Professional Modifier None Typical Low $758.58 Median $758.58 Typical High $1,348.96 | Professional | None | $758.58 | $758.58 | $1,348.96 |
United Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
United Setting Professional Modifier None Typical Low $851.14 Median $1,202.26 Typical High $1,513.56 | Professional | None | $851.14 | $1,202.26 | $1,513.56 |
6 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 $380.19 Median $380.19 Typical High $380.19 | Professional | 52 · Reduced service | $380.19 | $380.19 | $380.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | 53 · Discontinued | $151.36 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $562.34 Median $562.34 Typical High $562.34 | Professional | 54 · Surgery only | $562.34 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | 55 · Aftercare only | $112.20 | $112.20 | $112.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | 56 · Pre-op care only | $75.86 | $75.86 | $75.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $524.81 Median $524.81 Typical High $524.81 | Professional | 78 · Unplanned return to OR | $524.81 | $524.81 | $524.81 |
Where Maine sits
The same service costs 7.2 times more in Oklahoma than in Utah. 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· 32nd of 51
$1,072
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.