How much rates vary
Facilitymedian $2,692 · 10th to 90th $708 to $7,079Professionalmedian $1,905 · 10th to 90th $1,479 to $2,884
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 $1,548.82 Median $1,905.46 Typical High $1,905.46 | Professional | None | $1,548.82 | $1,905.46 | $1,905.46 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,479.11 Median $1,905.46 Typical High $2,884.03 | Professional | None | $1,479.11 | $1,905.46 | $2,884.03 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $2,187.76 Median $2,884.03 Typical High $4,365.16 | Professional | 50 · Both sides | $2,187.76 | $2,884.03 | $4,365.16 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $933.25 Median $1,202.26 Typical High $1,819.70 | Professional | 62 · Two surgeons | $933.25 | $1,202.26 | $1,819.70 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $234.42 Median $309.03 Typical High $457.09 | Professional | 80 · Assistant surgeon | $234.42 | $309.03 | $457.09 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $204.17 Median $269.15 Typical High $407.38 | Professional | AS · PA/NP assist | $204.17 | $269.15 | $407.38 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $4,168.69 Typical High $6,606.93 | Facility | None | $707.95 | $4,168.69 | $6,606.93 |
Cigna Setting Professional Modifier None Typical Low $1,445.44 Median $2,089.30 Typical High $3,019.95 | Professional | None | $1,445.44 | $2,089.30 | $3,019.95 |
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 $1,479.11 Median $1,862.09 Typical High $2,630.27 | Professional | None | $1,479.11 | $1,862.09 | $2,630.27 |
Martin's Point Setting Professional Modifier None Typical Low $1,778.28 Median $1,905.46 Typical High $1,905.46 | Professional | None | $1,778.28 | $1,905.46 | $1,905.46 |
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 $1,288.25 Median $1,862.09 Typical High $2,511.89 | Professional | None | $1,288.25 | $1,862.09 | $2,511.89 |
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 $776.25 Median $954.99 Typical High $954.99 | Professional | 52 · Reduced service | $776.25 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $380.19 Typical High $380.19 | Professional | 53 · Discontinued | $309.03 | $380.19 | $380.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $1,412.54 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,148.15 | $1,412.54 | $1,412.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $229.09 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $190.55 Typical High $190.55 | Professional | 56 · Pre-op care only | $154.88 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,318.26 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $891.25 Median $954.99 Typical High $954.99 | Professional | 52 · Reduced service | $891.25 | $954.99 | $954.99 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $354.81 Median $380.19 Typical High $380.19 | Professional | 53 · Discontinued | $354.81 | $380.19 | $380.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,318.26 Median $1,412.54 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,318.26 | $1,412.54 | $1,412.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $263.03 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $263.03 | $288.40 | $288.40 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $177.83 Median $190.55 Typical High $190.55 | Professional | 56 · Pre-op care only | $177.83 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,230.27 Median $1,318.26 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,230.27 | $1,318.26 | $1,318.26 |
Where Maine sits
The same service costs 5.5 times more in Alaska 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
AK $15,938KY $2,890
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.