How much rates vary
Facilitymedian $3,020 · 10th to 90th $537 to $33,884Professionalmedian $389 · 10th to 90th $309 to $603
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 $309.03 Median $363.08 Typical High $363.08 | Professional | None | $309.03 | $363.08 | $363.08 |
Anthem BCBS Setting Professional Modifier None Typical Low $309.03 Median $407.38 Typical High $602.56 | Professional | None | $309.03 | $407.38 | $602.56 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $48.98 Median $64.57 Typical High $97.72 | Professional | 80 · Assistant surgeon | $48.98 | $64.57 | $97.72 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $43.65 Median $56.23 Typical High $85.11 | Professional | AS · PA/NP assist | $43.65 | $56.23 | $85.11 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $18,197.01 Typical High $28,840.32 | Facility | None | $537.03 | $18,197.01 | $28,840.32 |
Cigna Setting Professional Modifier None Typical Low $346.74 Median $389.05 Typical High $602.56 | Professional | None | $346.74 | $389.05 | $602.56 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,818.38 Median $3,019.95 Typical High $33,884.42 | Facility | None | $2,818.38 | $3,019.95 | $33,884.42 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $302.00 Median $389.05 Typical High $602.56 | Professional | None | $302.00 | $389.05 | $602.56 |
Martin's Point Setting Professional Modifier None Typical Low $363.08 Median $363.08 Typical High $363.08 | Professional | None | $363.08 | $363.08 | $363.08 |
United Setting Facility Modifier None Typical Low $2,818.38 Median $3,019.95 Typical High $33,884.42 | Facility | None | $2,818.38 | $3,019.95 | $33,884.42 |
United Setting Professional Modifier None Typical Low $288.40 Median $371.54 Typical High $512.86 | Professional | None | $288.40 | $371.54 | $512.86 |
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 $154.88 Median $181.97 Typical High $181.97 | Professional | 52 · Reduced service | $154.88 | $181.97 | $181.97 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $61.66 Median $72.44 Typical High $72.44 | Professional | 53 · Discontinued | $61.66 | $72.44 | $72.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $234.42 Median $269.15 Typical High $269.15 | Professional | 54 · Surgery only | $234.42 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $46.77 Median $53.70 Typical High $53.70 | Professional | 55 · Aftercare only | $46.77 | $53.70 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $30.90 Median $36.31 Typical High $36.31 | Professional | 56 · Pre-op care only | $30.90 | $36.31 | $36.31 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $218.78 Median $251.19 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $218.78 | $251.19 | $251.19 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $177.83 Median $181.97 Typical High $181.97 | Professional | 52 · Reduced service | $177.83 | $181.97 | $181.97 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $72.44 Median $72.44 Typical High $72.44 | Professional | 53 · Discontinued | $72.44 | $72.44 | $72.44 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $269.15 Median $269.15 Typical High $269.15 | Professional | 54 · Surgery only | $269.15 | $269.15 | $269.15 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $53.70 Median $53.70 Typical High $53.70 | Professional | 55 · Aftercare only | $53.70 | $53.70 | $53.70 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $36.31 Median $36.31 Typical High $36.31 | Professional | 56 · Pre-op care only | $36.31 | $36.31 | $36.31 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $251.19 Median $251.19 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $251.19 | $251.19 | $251.19 |
Where Maine sits
The same service costs 29.1 times more in Alabama than in Montana. 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
AL $30,626MT $1,051
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.