How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $2,239 · 10th to 90th $1,698 to $3,311
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $1,778.28 Median $2,089.30 Typical High $2,089.30 | Professional | None | $1,778.28 | $2,089.30 | $2,089.30 |
Anthem BCBS Setting Facility Modifier None Typical Low $12,589.25 Median $16,218.10 Typical High $16,982.44 | Facility | None | $12,589.25 | $16,218.10 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,698.24 Median $2,290.87 Typical High $3,467.37 | Professional | None | $1,698.24 | $2,290.87 | $3,467.37 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $269.15 Median $346.74 Typical High $524.81 | Professional | 80 · Assistant surgeon | $269.15 | $346.74 | $524.81 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $234.42 Median $302.00 Typical High $467.74 | Professional | AS · PA/NP assist | $234.42 | $302.00 | $467.74 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $707.95 Typical High $2,290.87 | Facility | None | $151.36 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,905.46 Median $2,511.89 Typical High $3,801.89 | Professional | None | $1,905.46 | $2,511.89 | $3,801.89 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,737.80 Median $2,344.23 Typical High $3,311.31 | Professional | None | $1,737.80 | $2,344.23 | $3,311.31 |
Martin's Point Setting Professional Modifier None Typical Low $1,778.28 Median $2,089.30 Typical High $2,089.30 | Professional | None | $1,778.28 | $2,089.30 | $2,089.30 |
United Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $1,698.24 Median $2,398.83 Typical High $3,388.44 | Professional | None | $1,698.24 | $2,398.83 | $3,388.44 |
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 $891.25 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $891.25 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $354.81 Median $416.87 Typical High $416.87 | Professional | 53 · Discontinued | $354.81 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,318.26 Median $1,548.82 Typical High $1,548.82 | Professional | 54 · Surgery only | $1,318.26 | $1,548.82 | $1,548.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $263.03 Median $309.03 Typical High $309.03 | Professional | 55 · Aftercare only | $263.03 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $177.83 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $177.83 | $208.93 | $208.93 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,230.27 Median $1,445.44 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $1,230.27 | $1,445.44 | $1,445.44 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,000.00 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $1,000.00 | $1,047.13 | $1,047.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $398.11 Median $416.87 Typical High $416.87 | Professional | 53 · Discontinued | $398.11 | $416.87 | $416.87 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,513.56 Median $1,548.82 Typical High $1,548.82 | Professional | 54 · Surgery only | $1,513.56 | $1,548.82 | $1,548.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $302.00 Median $309.03 Typical High $309.03 | Professional | 55 · Aftercare only | $302.00 | $309.03 | $309.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $199.53 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $199.53 | $208.93 | $208.93 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,412.54 Median $1,445.44 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $1,412.54 | $1,445.44 | $1,445.44 |
Where Maine sits
The same service costs 5.4 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· 23rd of 51
$2,291
AK $6,026TX $1,122
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.