How much rates vary
Facilitymedian $2,512 · 10th to 90th $708 to $5,754Professionalmedian $1,000 · 10th to 90th $741 to $1,479
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 $776.25 Median $1,000.00 Typical High $1,000.00 | Professional | None | $776.25 | $1,000.00 | $1,000.00 |
Anthem BCBS Setting Professional Modifier None Typical Low $741.31 Median $977.24 Typical High $1,479.11 | Professional | None | $741.31 | $977.24 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,122.02 Median $1,479.11 Typical High $2,187.76 | Professional | 50 · Both sides | $1,122.02 | $1,479.11 | $2,187.76 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $120.23 Median $154.88 Typical High $234.42 | Professional | 80 · Assistant surgeon | $120.23 | $154.88 | $234.42 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $104.71 Median $138.04 Typical High $204.17 | Professional | AS · PA/NP assist | $104.71 | $138.04 | $204.17 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $3,388.44 Typical High $5,495.41 | Facility | None | $707.95 | $3,388.44 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $870.96 Median $1,071.52 Typical High $1,548.82 | Professional | None | $870.96 | $1,071.52 | $1,548.82 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $758.58 Median $891.25 Typical High $1,348.96 | Professional | None | $758.58 | $891.25 | $1,348.96 |
Martin's Point Setting Professional Modifier None Typical Low $912.01 Median $1,000.00 Typical High $1,000.00 | Professional | None | $912.01 | $1,000.00 | $1,000.00 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
United Setting Professional Modifier None Typical Low $691.83 Median $933.25 Typical High $1,288.25 | Professional | None | $691.83 | $933.25 | $1,288.25 |
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 $389.05 Median $489.78 Typical High $489.78 | Professional | 52 · Reduced service | $389.05 | $489.78 | $489.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $199.53 Typical High $199.53 | Professional | 53 · Discontinued | $154.88 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $575.44 Median $741.31 Typical High $741.31 | Professional | 54 · Surgery only | $575.44 | $741.31 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $147.91 Typical High $147.91 | Professional | 55 · Aftercare only | $114.82 | $147.91 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $77.62 Median $100.00 Typical High $100.00 | Professional | 56 · Pre-op care only | $77.62 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $691.83 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $537.03 | $691.83 | $691.83 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $457.09 Median $489.78 Typical High $489.78 | Professional | 52 · Reduced service | $457.09 | $489.78 | $489.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $181.97 Median $199.53 Typical High $199.53 | Professional | 53 · Discontinued | $181.97 | $199.53 | $199.53 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $676.08 Median $741.31 Typical High $741.31 | Professional | 54 · Surgery only | $676.08 | $741.31 | $741.31 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $134.90 Median $147.91 Typical High $147.91 | Professional | 55 · Aftercare only | $134.90 | $147.91 | $147.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $91.20 Median $100.00 Typical High $100.00 | Professional | 56 · Pre-op care only | $91.20 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $691.83 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $630.96 | $691.83 | $691.83 |
Where Maine sits
The same service costs 16.6 times more in Alaska than in Texas. 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· 26th of 51
$1,000
AK $3,090TX $186
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.