How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $2,042 · 10th to 90th $1,549 to $3,020
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 $1,584.89 Median $1,905.46 Typical High $1,905.46 | Professional | None | $1,584.89 | $1,905.46 | $1,905.46 |
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 $1,548.82 Median $2,137.96 Typical High $3,235.94 | Professional | None | $1,548.82 | $2,137.96 | $3,235.94 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $245.47 Median $323.59 Typical High $489.78 | Professional | 80 · Assistant surgeon | $245.47 | $323.59 | $489.78 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $218.78 Median $281.84 Typical High $426.58 | Professional | AS · PA/NP assist | $218.78 | $281.84 | $426.58 |
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 $1,621.81 Median $2,290.87 Typical High $3,467.37 | Professional | None | $1,621.81 | $2,290.87 | $3,467.37 |
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 $1,584.89 Median $2,137.96 Typical High $3,090.30 | Professional | None | $1,584.89 | $2,137.96 | $3,090.30 |
Martin's Point Setting Professional Modifier None Typical Low $1,584.89 Median $1,905.46 Typical High $1,905.46 | Professional | None | $1,584.89 | $1,905.46 | $1,905.46 |
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 $1,548.82 Median $2,187.76 Typical High $3,090.30 | Professional | None | $1,548.82 | $2,187.76 | $3,090.30 |
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 $794.33 Median $954.99 Typical High $954.99 | Professional | 52 · Reduced service | $794.33 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $380.19 Typical High $380.19 | Professional | 53 · Discontinued | $323.59 | $380.19 | $380.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,445.44 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,202.26 | $1,445.44 | $1,445.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $239.88 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $190.55 Typical High $190.55 | Professional | 56 · Pre-op care only | $158.49 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,348.96 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,348.96 | $1,348.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $812.83 Median $954.99 Typical High $954.99 | Professional | 52 · Reduced service | $812.83 | $954.99 | $954.99 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $380.19 Typical High $380.19 | Professional | 53 · Discontinued | $323.59 | $380.19 | $380.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,230.27 Median $1,445.44 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,230.27 | $1,445.44 | $1,445.44 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $245.47 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $245.47 | $288.40 | $288.40 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $190.55 Typical High $190.55 | Professional | 56 · Pre-op care only | $162.18 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,148.15 Median $1,348.96 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,148.15 | $1,348.96 | $1,348.96 |
Where Maine sits
The same service costs 8.1 times more in Maine 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
ME $17,891MD $2,222
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.