How much rates vary
Facilitymedian $2,512 · 10th to 90th $708 to $5,754Professionalmedian $1,778 · 10th to 90th $1,318 to $2,570
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 $1,412.54 Median $1,778.28 Typical High $1,778.28 | Professional | None | $1,412.54 | $1,778.28 | $1,778.28 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,318.26 Median $1,737.80 Typical High $2,630.27 | Professional | None | $1,318.26 | $1,737.80 | $2,630.27 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $831.76 Median $1,096.48 Typical High $1,659.59 | Professional | 62 · Two surgeons | $831.76 | $1,096.48 | $1,659.59 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $213.80 Median $275.42 Typical High $416.87 | Professional | 80 · Assistant surgeon | $213.80 | $275.42 | $416.87 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $186.21 Median $245.47 Typical High $363.08 | Professional | AS · PA/NP assist | $186.21 | $245.47 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $3,388.44 Typical High $5,495.41 | Facility | None | $707.95 | $3,388.44 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $1,412.54 Median $1,905.46 Typical High $2,818.38 | Professional | None | $1,412.54 | $1,905.46 | $2,818.38 |
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 $1,348.96 Median $1,737.80 Typical High $2,398.83 | Professional | None | $1,348.96 | $1,737.80 | $2,398.83 |
Martin's Point Setting Professional Modifier None Typical Low $1,621.81 Median $1,778.28 Typical High $1,778.28 | Professional | None | $1,621.81 | $1,778.28 | $1,778.28 |
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 $1,202.26 Median $1,737.80 Typical High $2,398.83 | Professional | None | $1,202.26 | $1,737.80 | $2,398.83 |
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 $707.95 Median $891.25 Typical High $891.25 | Professional | 52 · Reduced service | $707.95 | $891.25 | $891.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $288.40 Median $354.81 Typical High $354.81 | Professional | 53 · Discontinued | $288.40 | $354.81 | $354.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,318.26 Typical High $1,318.26 | Professional | 54 · Surgery only | $1,071.52 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $263.03 Typical High $263.03 | Professional | 55 · Aftercare only | $213.80 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $177.83 Typical High $177.83 | Professional | 56 · Pre-op care only | $141.25 | $177.83 | $177.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,230.27 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,230.27 | $1,230.27 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $812.83 Median $891.25 Typical High $891.25 | Professional | 52 · Reduced service | $812.83 | $891.25 | $891.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $354.81 Typical High $354.81 | Professional | 53 · Discontinued | $323.59 | $354.81 | $354.81 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,318.26 Typical High $1,318.26 | Professional | 54 · Surgery only | $1,202.26 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $245.47 Median $263.03 Typical High $263.03 | Professional | 55 · Aftercare only | $245.47 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $177.83 Typical High $177.83 | Professional | 56 · Pre-op care only | $162.18 | $177.83 | $177.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,230.27 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,230.27 | $1,230.27 |
Where Maine sits
The same service costs 17.0 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· 26th of 51
$1,778
AK $5,495TX $324
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.