How much rates vary
Facilitymedian $2,754 · 10th to 90th $813 to $7,079Professionalmedian $1,096 · 10th to 90th $851 to $1,698
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 $891.25 Median $1,096.48 Typical High $1,096.48 | Professional | None | $891.25 | $1,096.48 | $1,096.48 |
Anthem BCBS Setting Professional Modifier None Typical Low $891.25 Median $1,148.15 Typical High $1,698.24 | Professional | None | $891.25 | $1,148.15 | $1,698.24 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $549.54 Median $724.44 Typical High $1,071.52 | Professional | 62 · Two surgeons | $549.54 | $724.44 | $1,071.52 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $141.25 Median $181.97 Typical High $275.42 | Professional | 80 · Assistant surgeon | $141.25 | $181.97 | $275.42 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $123.03 Median $162.18 Typical High $239.88 | Professional | AS · PA/NP assist | $123.03 | $162.18 | $239.88 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $5,011.87 Typical High $6,606.93 | Facility | None | $812.83 | $5,011.87 | $6,606.93 |
Cigna Setting Professional Modifier None Typical Low $933.25 Median $1,202.26 Typical High $1,737.80 | Professional | None | $933.25 | $1,202.26 | $1,737.80 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $831.76 Median $1,071.52 Typical High $1,659.59 | Professional | None | $831.76 | $1,071.52 | $1,659.59 |
Martin's Point Setting Professional Modifier None Typical Low $891.25 Median $1,096.48 Typical High $1,096.48 | Professional | None | $891.25 | $1,096.48 | $1,096.48 |
United Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
United Setting Professional Modifier None Typical Low $776.25 Median $1,047.13 Typical High $1,445.44 | Professional | None | $776.25 | $1,047.13 | $1,445.44 |
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 $446.68 Median $537.03 Typical High $537.03 | Professional | 52 · Reduced service | $446.68 | $537.03 | $537.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $177.83 Median $218.78 Typical High $218.78 | Professional | 53 · Discontinued | $177.83 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $676.08 Median $812.83 Typical High $812.83 | Professional | 54 · Surgery only | $676.08 | $812.83 | $812.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $134.90 Median $162.18 Typical High $162.18 | Professional | 55 · Aftercare only | $134.90 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $89.13 Median $109.65 Typical High $109.65 | Professional | 56 · Pre-op care only | $89.13 | $109.65 | $109.65 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $630.96 Median $758.58 Typical High $758.58 | Professional | 78 · Unplanned return to OR | $630.96 | $758.58 | $758.58 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $501.19 Median $537.03 Typical High $537.03 | Professional | 52 · Reduced service | $501.19 | $537.03 | $537.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $199.53 Median $218.78 Typical High $218.78 | Professional | 53 · Discontinued | $199.53 | $218.78 | $218.78 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $758.58 Median $812.83 Typical High $812.83 | Professional | 54 · Surgery only | $758.58 | $812.83 | $812.83 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $162.18 Typical High $162.18 | Professional | 55 · Aftercare only | $151.36 | $162.18 | $162.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $100.00 Median $109.65 Typical High $109.65 | Professional | 56 · Pre-op care only | $100.00 | $109.65 | $109.65 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $707.95 Median $758.58 Typical High $758.58 | Professional | 78 · Unplanned return to OR | $707.95 | $758.58 | $758.58 |
Where Maine sits
The same service costs 5.1 times more in Oklahoma than in Kentucky. 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
OK $11,738KY $2,311
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.