How much rates vary
Facilitymedian $2,291 · 10th to 90th $813 to $6,026Professionalmedian $1,288 · 10th to 90th $977 to $1,950
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 $1,023.29 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,023.29 | $1,288.25 | $1,288.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,000.00 Median $1,288.25 Typical High $1,949.84 | Professional | None | $1,000.00 | $1,288.25 | $1,949.84 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,513.56 Median $1,949.84 Typical High $2,951.21 | Professional | 50 · Both sides | $1,513.56 | $1,949.84 | $2,951.21 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $158.49 Median $208.93 Typical High $309.03 | Professional | 80 · Assistant surgeon | $158.49 | $208.93 | $309.03 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $141.25 Median $181.97 Typical High $275.42 | Professional | AS · PA/NP assist | $141.25 | $181.97 | $275.42 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $4,168.69 Typical High $6,606.93 | Facility | None | $812.83 | $4,168.69 | $6,606.93 |
Cigna Setting Professional Modifier None Typical Low $1,148.15 Median $1,412.54 Typical High $2,137.96 | Professional | None | $1,148.15 | $1,412.54 | $2,137.96 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $977.24 Median $1,148.15 Typical High $1,819.70 | Professional | None | $977.24 | $1,148.15 | $1,819.70 |
Martin's Point Setting Professional Modifier None Typical Low $1,202.26 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,202.26 | $1,288.25 | $1,288.25 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
United Setting Professional Modifier None Typical Low $870.96 Median $1,174.90 Typical High $1,621.81 | Professional | None | $870.96 | $1,174.90 | $1,621.81 |
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 $512.86 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $512.86 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $204.17 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $204.17 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $776.25 Median $954.99 Typical High $954.99 | Professional | 54 · Surgery only | $776.25 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $154.88 Median $190.55 Typical High $190.55 | Professional | 55 · Aftercare only | $154.88 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $102.33 Median $128.82 Typical High $128.82 | Professional | 56 · Pre-op care only | $102.33 | $128.82 | $128.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $724.44 Median $891.25 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $724.44 | $891.25 | $891.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $602.56 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $602.56 | $645.65 | $645.65 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $239.88 | $257.04 | $257.04 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $891.25 Median $954.99 Typical High $954.99 | Professional | 54 · Surgery only | $891.25 | $954.99 | $954.99 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $177.83 Median $190.55 Typical High $190.55 | Professional | 55 · Aftercare only | $177.83 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $128.82 Typical High $128.82 | Professional | 56 · Pre-op care only | $120.23 | $128.82 | $128.82 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $831.76 Median $891.25 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $831.76 | $891.25 | $891.25 |
Where Maine sits
The same service costs 8.3 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· 33rd of 51
$1,288
AK $4,169TX $501
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.