How much rates vary
Facilitymedian $2,692 · 10th to 90th $708 to $6,310Professionalmedian $871 · 10th to 90th $692 to $1,380
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 $724.44 Median $870.96 Typical High $870.96 | Professional | None | $724.44 | $870.96 | $870.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $707.95 Median $912.01 Typical High $1,380.38 | Professional | None | $707.95 | $912.01 | $1,380.38 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,047.13 Median $1,380.38 Typical High $2,089.30 | Professional | 50 · Both sides | $1,047.13 | $1,380.38 | $2,089.30 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $112.20 Median $147.91 Typical High $218.78 | Professional | 80 · Assistant surgeon | $112.20 | $147.91 | $218.78 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $97.72 Median $128.82 Typical High $194.98 | Professional | AS · PA/NP assist | $97.72 | $128.82 | $194.98 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $2,238.72 Typical High $2,951.21 | Facility | None | $707.95 | $2,238.72 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $794.33 Median $1,000.00 Typical High $1,479.11 | Professional | None | $794.33 | $1,000.00 | $1,479.11 |
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 $676.08 Median $851.14 Typical High $1,318.26 | Professional | None | $676.08 | $851.14 | $1,318.26 |
Martin's Point Setting Professional Modifier None Typical Low $851.14 Median $870.96 Typical High $870.96 | Professional | None | $851.14 | $870.96 | $870.96 |
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 $602.56 Median $794.33 Typical High $1,122.02 | Professional | None | $602.56 | $794.33 | $1,122.02 |
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 $363.08 Median $436.52 Typical High $436.52 | Professional | 52 · Reduced service | $363.08 | $436.52 | $436.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $177.83 Typical High $177.83 | Professional | 53 · Discontinued | $144.54 | $177.83 | $177.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $537.03 Median $660.69 Typical High $660.69 | Professional | 54 · Surgery only | $537.03 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $131.83 Typical High $131.83 | Professional | 55 · Aftercare only | $109.65 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $87.10 Typical High $87.10 | Professional | 56 · Pre-op care only | $72.44 | $87.10 | $87.10 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $501.19 Median $616.60 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $501.19 | $616.60 | $616.60 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $426.58 Median $436.52 Typical High $436.52 | Professional | 52 · Reduced service | $426.58 | $436.52 | $436.52 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $177.83 Typical High $177.83 | Professional | 53 · Discontinued | $169.82 | $177.83 | $177.83 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $660.69 Typical High $660.69 | Professional | 54 · Surgery only | $630.96 | $660.69 | $660.69 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $128.82 Median $131.83 Typical High $131.83 | Professional | 55 · Aftercare only | $128.82 | $131.83 | $131.83 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $87.10 Typical High $87.10 | Professional | 56 · Pre-op care only | $85.11 | $87.10 | $87.10 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $616.60 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $588.84 | $616.60 | $616.60 |
Where Maine sits
The same service costs 19.5 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· 30th of 51
$871
AK $2,951TX $151
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.