How much rates vary
Facilitymedian $2,291 · 10th to 90th $1,148 to $8,511Professionalmedian $1,318 · 10th to 90th $1,000 to $1,995
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 $1,047.13 Median $1,318.26 Typical High $1,318.26 | Professional | None | $1,047.13 | $1,318.26 | $1,318.26 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,023.29 Median $1,318.26 Typical High $1,995.26 | Professional | None | $1,023.29 | $1,318.26 | $1,995.26 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,513.56 Median $1,995.26 Typical High $3,019.95 | Professional | 50 · Both sides | $1,513.56 | $1,995.26 | $3,019.95 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $162.18 Median $213.80 Typical High $316.23 | Professional | 80 · Assistant surgeon | $162.18 | $213.80 | $316.23 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $141.25 Median $186.21 Typical High $281.84 | Professional | AS · PA/NP assist | $141.25 | $186.21 | $281.84 |
Cigna Setting Facility Modifier None Typical Low $1,148.15 Median $5,888.44 Typical High $9,332.54 | Facility | None | $1,148.15 | $5,888.44 | $9,332.54 |
Cigna Setting Professional Modifier None Typical Low $1,174.90 Median $1,445.44 Typical High $2,089.30 | Professional | None | $1,174.90 | $1,445.44 | $2,089.30 |
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 $1,000.00 Median $1,288.25 Typical High $1,862.09 | Professional | None | $1,000.00 | $1,288.25 | $1,862.09 |
Martin's Point Setting Professional Modifier None Typical Low $1,230.27 Median $1,318.26 Typical High $1,318.26 | Professional | None | $1,230.27 | $1,318.26 | $1,318.26 |
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 $977.24 Median $1,288.25 Typical High $1,737.80 | Professional | None | $977.24 | $1,288.25 | $1,737.80 |
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 $524.81 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $524.81 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $208.93 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $208.93 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $977.24 Typical High $977.24 | Professional | 54 · Surgery only | $794.33 | $977.24 | $977.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $194.98 Typical High $194.98 | Professional | 55 · Aftercare only | $158.49 | $194.98 | $194.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $104.71 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $104.71 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $912.01 Typical High $912.01 | Professional | 78 · Unplanned return to OR | $741.31 | $912.01 | $912.01 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $616.60 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $616.60 | $645.65 | $645.65 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $245.47 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $977.24 Typical High $977.24 | Professional | 54 · Surgery only | $912.01 | $977.24 | $977.24 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $194.98 Typical High $194.98 | Professional | 55 · Aftercare only | $181.97 | $194.98 | $194.98 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $123.03 | $131.83 | $131.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $912.01 Typical High $912.01 | Professional | 78 · Unplanned return to OR | $851.14 | $912.01 | $912.01 |
Where Maine sits
The same service costs 7.9 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· 31st of 51
$1,318
AK $4,266TX $537
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.