How much rates vary
Facilitymedian $2,512 · 10th to 90th $1,148 to $5,754Professionalmedian $1,349 · 10th to 90th $1,072 to $2,042
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 $1,096.48 Median $1,318.26 Typical High $1,905.46 | Professional | None | $1,096.48 | $1,318.26 | $1,905.46 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,047.13 Median $1,445.44 Typical High $2,187.76 | Professional | None | $1,047.13 | $1,445.44 | $2,187.76 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $169.82 Median $218.78 Typical High $331.13 | Professional | 80 · Assistant surgeon | $169.82 | $218.78 | $331.13 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $147.91 Median $190.55 Typical High $288.40 | Professional | AS · PA/NP assist | $147.91 | $190.55 | $288.40 |
Cigna Setting Facility Modifier None Typical Low $1,148.15 Median $3,388.44 Typical High $5,495.41 | Facility | None | $1,148.15 | $3,388.44 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $1,122.02 Median $1,412.54 Typical High $2,398.83 | Professional | None | $1,122.02 | $1,412.54 | $2,398.83 |
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 $1,071.52 Median $1,380.38 Typical High $1,995.26 | Professional | None | $1,071.52 | $1,380.38 | $1,995.26 |
Martin's Point Setting Professional Modifier None Typical Low $1,096.48 Median $1,318.26 Typical High $1,905.46 | Professional | None | $1,096.48 | $1,318.26 | $1,905.46 |
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 $1,047.13 Median $1,412.54 Typical High $2,137.96 | Professional | None | $1,047.13 | $1,412.54 | $2,137.96 |
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 $549.54 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $549.54 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $218.78 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $218.78 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $831.76 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $165.96 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $109.65 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $776.25 | $933.25 | $933.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $575.44 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $575.44 | $660.69 | $660.69 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $229.09 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $870.96 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $870.96 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $173.78 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $173.78 | $199.53 | $199.53 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $114.82 | $131.83 | $131.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $812.83 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $812.83 | $933.25 | $933.25 |
Where Maine sits
The same service costs 6.2 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· 25th of 51
$1,380
AK $4,365TX $708
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.