How much rates vary
Facilitymedian $3,020 · 10th to 90th $708 to $22,909Professionalmedian $5,012 · 10th to 90th $3,890 to $7,413
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 $4,073.80 Median $5,011.87 Typical High $5,011.87 | Professional | None | $4,073.80 | $5,011.87 | $5,011.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $3,801.89 Median $5,011.87 Typical High $7,413.10 | Professional | None | $3,801.89 | $5,011.87 | $7,413.10 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $5,754.40 Median $7,413.10 Typical High $11,220.18 | Professional | 50 · Both sides | $5,754.40 | $7,413.10 | $11,220.18 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,398.83 Median $3,162.28 Typical High $4,677.35 | Professional | 62 · Two surgeons | $2,398.83 | $3,162.28 | $4,677.35 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $616.60 Median $794.33 Typical High $1,202.26 | Professional | 80 · Assistant surgeon | $616.60 | $794.33 | $1,202.26 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $537.03 Median $691.83 Typical High $1,047.13 | Professional | AS · PA/NP assist | $537.03 | $691.83 | $1,047.13 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $15,488.17 Typical High $25,118.86 | Facility | None | $707.95 | $15,488.17 | $25,118.86 |
Cigna Setting Professional Modifier None Typical Low $4,365.16 Median $5,495.41 Typical High $8,317.64 | Professional | None | $4,365.16 | $5,495.41 | $8,317.64 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,818.38 Median $3,019.95 Typical High $10,232.93 | Facility | None | $2,818.38 | $3,019.95 | $10,232.93 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $3,890.45 Median $5,011.87 Typical High $6,760.83 | Professional | None | $3,890.45 | $5,011.87 | $6,760.83 |
Martin's Point Setting Professional Modifier None Typical Low $4,570.88 Median $5,011.87 Typical High $5,011.87 | Professional | None | $4,570.88 | $5,011.87 | $5,011.87 |
United Setting Facility Modifier None Typical Low $2,818.38 Median $3,019.95 Typical High $10,232.93 | Facility | None | $2,818.38 | $3,019.95 | $10,232.93 |
United Setting Professional Modifier None Typical Low $3,801.89 Median $5,011.87 Typical High $6,760.83 | Professional | None | $3,801.89 | $5,011.87 | $6,760.83 |
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 $2,041.74 Median $2,511.89 Typical High $2,511.89 | Professional | 52 · Reduced service | $2,041.74 | $2,511.89 | $2,511.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $812.83 Median $1,000.00 Typical High $1,000.00 | Professional | 53 · Discontinued | $812.83 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3,019.95 Median $3,715.35 Typical High $3,715.35 | Professional | 54 · Surgery only | $3,019.95 | $3,715.35 | $3,715.35 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $602.56 Median $741.31 Typical High $741.31 | Professional | 55 · Aftercare only | $602.56 | $741.31 | $741.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $407.38 Median $501.19 Typical High $501.19 | Professional | 56 · Pre-op care only | $407.38 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,818.38 Median $3,467.37 Typical High $3,467.37 | Professional | 78 · Unplanned return to OR | $2,818.38 | $3,467.37 | $3,467.37 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2,290.87 Median $2,511.89 Typical High $2,511.89 | Professional | 52 · Reduced service | $2,290.87 | $2,511.89 | $2,511.89 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $933.25 Median $1,000.00 Typical High $1,000.00 | Professional | 53 · Discontinued | $933.25 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $3,467.37 Median $3,715.35 Typical High $3,715.35 | Professional | 54 · Surgery only | $3,467.37 | $3,715.35 | $3,715.35 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $691.83 Median $741.31 Typical High $741.31 | Professional | 55 · Aftercare only | $691.83 | $741.31 | $741.31 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $457.09 Median $501.19 Typical High $501.19 | Professional | 56 · Pre-op care only | $457.09 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,235.94 Median $3,467.37 Typical High $3,467.37 | Professional | 78 · Unplanned return to OR | $3,235.94 | $3,467.37 | $3,467.37 |
Where Maine sits
The same service costs 20.4 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· 28th of 51
$5,012
AK $15,849TX $776
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.