How much rates vary
Facilitymedian $2,512 · 10th to 90th $1,148 to $5,754Professionalmedian $933 · 10th to 90th $724 to $1,445
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 $794.33 Median $870.96 Typical High $870.96 | Professional | None | $794.33 | $870.96 | $870.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $724.44 Median $1,000.00 Typical High $1,548.82 | Professional | None | $724.44 | $1,000.00 | $1,548.82 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $114.82 Median $151.36 Typical High $229.09 | Professional | 80 · Assistant surgeon | $114.82 | $151.36 | $229.09 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $102.33 Median $131.83 Typical High $199.53 | Professional | AS · PA/NP assist | $102.33 | $131.83 | $199.53 |
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 $758.58 Median $977.24 Typical High $1,584.89 | Professional | None | $758.58 | $977.24 | $1,584.89 |
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 $741.31 Median $977.24 Typical High $1,412.54 | Professional | None | $741.31 | $977.24 | $1,412.54 |
Martin's Point Setting Professional Modifier None Typical Low $794.33 Median $870.96 Typical High $870.96 | Professional | None | $794.33 | $870.96 | $870.96 |
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 $691.83 Median $1,023.29 Typical High $1,513.56 | Professional | None | $691.83 | $1,023.29 | $1,513.56 |
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 $398.11 Median $436.52 Typical High $436.52 | Professional | 52 · Reduced service | $398.11 | $436.52 | $436.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $173.78 Typical High $173.78 | Professional | 53 · Discontinued | $158.49 | $173.78 | $173.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $660.69 Typical High $660.69 | Professional | 54 · Surgery only | $588.84 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $131.83 Typical High $131.83 | Professional | 55 · Aftercare only | $120.23 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $87.10 Typical High $87.10 | Professional | 56 · Pre-op care only | $79.43 | $87.10 | $87.10 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $616.60 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $549.54 | $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 $173.78 Typical High $173.78 | Professional | 53 · Discontinued | $169.82 | $173.78 | $173.78 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $645.65 Median $660.69 Typical High $660.69 | Professional | 54 · Surgery only | $645.65 | $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 $602.56 Median $616.60 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $602.56 | $616.60 | $616.60 |
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· 24th of 51
$955
AK $3,020TX $490
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.