How much rates vary
Facilitymedian $2,754 · 10th to 90th $1,000 to $7,079Professionalmedian $1,288 · 10th to 90th $1,000 to $1,950
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 $1,071.52 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,071.52 | $1,288.25 | $1,288.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,000.00 Median $1,318.26 Typical High $1,995.26 | Professional | None | $1,000.00 | $1,318.26 | $1,995.26 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,513.56 Median $1,995.26 Typical High $2,951.21 | Professional | 50 · Both sides | $1,513.56 | $1,995.26 | $2,951.21 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $630.96 Median $831.76 Typical High $1,258.93 | Professional | 62 · Two surgeons | $630.96 | $831.76 | $1,258.93 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $162.18 Median $208.93 Typical High $316.23 | Professional | 80 · Assistant surgeon | $162.18 | $208.93 | $316.23 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $141.25 Median $186.21 Typical High $275.42 | Professional | AS · PA/NP assist | $141.25 | $186.21 | $275.42 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $4,168.69 Typical High $6,606.93 | Facility | None | $1,000.00 | $4,168.69 | $6,606.93 |
Cigna Setting Professional Modifier None Typical Low $1,174.90 Median $1,445.44 Typical High $2,089.30 | Professional | None | $1,174.90 | $1,445.44 | $2,089.30 |
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 $1,000.00 Median $1,288.25 Typical High $1,819.70 | Professional | None | $1,000.00 | $1,288.25 | $1,819.70 |
Martin's Point Setting Professional Modifier None Typical Low $1,202.26 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,202.26 | $1,288.25 | $1,288.25 |
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 $977.24 Median $1,288.25 Typical High $1,737.80 | Professional | None | $977.24 | $1,288.25 | $1,737.80 |
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 $524.81 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $524.81 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $213.80 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $213.80 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $977.24 Typical High $977.24 | Professional | 54 · Surgery only | $794.33 | $977.24 | $977.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $194.98 Typical High $194.98 | Professional | 55 · Aftercare only | $158.49 | $194.98 | $194.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $107.15 Median $128.82 Typical High $128.82 | Professional | 56 · Pre-op care only | $107.15 | $128.82 | $128.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $912.01 Typical High $912.01 | Professional | 78 · Unplanned return to OR | $741.31 | $912.01 | $912.01 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $602.56 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $602.56 | $645.65 | $645.65 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $239.88 | $257.04 | $257.04 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $977.24 Typical High $977.24 | Professional | 54 · Surgery only | $912.01 | $977.24 | $977.24 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $194.98 Typical High $194.98 | Professional | 55 · Aftercare only | $181.97 | $194.98 | $194.98 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $128.82 Typical High $128.82 | Professional | 56 · Pre-op care only | $120.23 | $128.82 | $128.82 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $912.01 Typical High $912.01 | Professional | 78 · Unplanned return to OR | $851.14 | $912.01 | $912.01 |
Where Maine sits
The same service costs 7.9 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· 30th of 51
$1,288
AK $4,169TX $525
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.