How much rates vary
Facilitymedian $1,202 · 10th to 90th $170 to $1,585Professionalmedian $191 · 10th to 90th $126 to $331
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 $125.89 Median $165.96 Typical High $302.00 | Professional | None | $125.89 | $165.96 | $302.00 |
Anthem BCBS Setting Professional Modifier None Typical Low $125.89 Median $204.17 Typical High $363.08 | Professional | None | $125.89 | $204.17 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $144.54 Median $323.59 Typical High $2,290.87 | Facility | None | $144.54 | $323.59 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $257.04 Typical High $371.54 | Professional | None | $173.78 | $257.04 | $371.54 |
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 $147.91 Median $213.80 Typical High $354.81 | Professional | None | $147.91 | $213.80 | $354.81 |
Martin's Point Setting Professional Modifier None Typical Low $125.89 Median $165.96 Typical High $302.00 | Professional | None | $125.89 | $165.96 | $302.00 |
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 $141.25 Median $190.55 Typical High $316.23 | Professional | None | $141.25 | $190.55 | $316.23 |
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 $63.10 Median $63.10 Typical High $83.18 | Professional | 52 · Reduced service | $63.10 | $63.10 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $25.70 Typical High $33.11 | Professional | 53 · Discontinued | $25.70 | $25.70 | $33.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $95.50 Typical High $125.89 | Professional | 54 · Surgery only | $95.50 | $95.50 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $19.05 Typical High $25.12 | Professional | 55 · Aftercare only | $19.05 | $19.05 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $12.59 Typical High $16.60 | Professional | 56 · Pre-op care only | $12.59 | $12.59 | $16.60 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $89.13 Median $89.13 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $89.13 | $89.13 | $117.49 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $63.10 Median $63.10 Typical High $83.18 | Professional | 52 · Reduced service | $63.10 | $63.10 | $83.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $25.70 Typical High $33.11 | Professional | 53 · Discontinued | $25.70 | $25.70 | $33.11 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $95.50 Typical High $125.89 | Professional | 54 · Surgery only | $95.50 | $95.50 | $125.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $19.05 Typical High $25.12 | Professional | 55 · Aftercare only | $19.05 | $19.05 | $25.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $12.59 Typical High $16.60 | Professional | 56 · Pre-op care only | $12.59 | $12.59 | $16.60 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $89.13 Median $89.13 Typical High $117.49 | Professional | 78 · Unplanned return to OR | $89.13 | $89.13 | $117.49 |
Where Maine sits
The same service costs 3.9 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· 27th of 51
$195
AK $550KY $141
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.