How much rates vary
Facilitymedian $2,239 · 10th to 90th $1,000 to $3,890Professionalmedian $1,122 · 10th to 90th $871 to $1,738
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 $912.01 Median $1,122.02 Typical High $1,122.02 | Professional | None | $912.01 | $1,122.02 | $1,122.02 |
Anthem BCBS Setting Professional Modifier None Typical Low $891.25 Median $1,148.15 Typical High $1,737.80 | Professional | None | $891.25 | $1,148.15 | $1,737.80 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $141.25 Median $181.97 Typical High $275.42 | Professional | 80 · Assistant surgeon | $141.25 | $181.97 | $275.42 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $123.03 Median $162.18 Typical High $239.88 | Professional | AS · PA/NP assist | $123.03 | $162.18 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $2,238.72 Typical High $2,951.21 | Facility | None | $1,000.00 | $2,238.72 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $1,023.29 Median $1,258.93 Typical High $1,862.09 | Professional | None | $1,023.29 | $1,258.93 | $1,862.09 |
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 $851.14 Median $1,071.52 Typical High $1,659.59 | Professional | None | $851.14 | $1,071.52 | $1,659.59 |
Martin's Point Setting Professional Modifier None Typical Low $954.99 Median $1,122.02 Typical High $1,122.02 | Professional | None | $954.99 | $1,122.02 | $1,122.02 |
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 $812.83 Median $1,071.52 Typical High $1,479.11 | Professional | None | $812.83 | $1,071.52 | $1,479.11 |
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 $457.09 Median $562.34 Typical High $562.34 | Professional | 52 · Reduced service | $457.09 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $181.97 Median $223.87 Typical High $223.87 | Professional | 53 · Discontinued | $181.97 | $223.87 | $223.87 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $676.08 Median $851.14 Typical High $851.14 | Professional | 54 · Surgery only | $676.08 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $134.90 Median $169.82 Typical High $169.82 | Professional | 55 · Aftercare only | $134.90 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $91.20 Median $112.20 Typical High $112.20 | Professional | 56 · Pre-op care only | $91.20 | $112.20 | $112.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $794.33 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $630.96 | $794.33 | $794.33 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $524.81 Median $562.34 Typical High $562.34 | Professional | 52 · Reduced service | $524.81 | $562.34 | $562.34 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $208.93 Median $223.87 Typical High $223.87 | Professional | 53 · Discontinued | $208.93 | $223.87 | $223.87 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $851.14 Typical High $851.14 | Professional | 54 · Surgery only | $794.33 | $851.14 | $851.14 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $169.82 Typical High $169.82 | Professional | 55 · Aftercare only | $158.49 | $169.82 | $169.82 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $104.71 Median $112.20 Typical High $112.20 | Professional | 56 · Pre-op care only | $104.71 | $112.20 | $112.20 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $794.33 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $741.31 | $794.33 | $794.33 |
Where Maine sits
The same service costs 3.0 times more in Wisconsin than in Maryland. 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.
Physician feeFacility fee
WI $7,993MD $2,690
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.