How much rates vary
Facilitymedian $2,512 · 10th to 90th $1,000 to $4,266Professionalmedian $1,202 · 10th to 90th $933 to $1,820
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 $977.24 Median $1,202.26 Typical High $1,202.26 | Professional | None | $977.24 | $1,202.26 | $1,202.26 |
Anthem BCBS Setting Professional Modifier None Typical Low $933.25 Median $1,230.27 Typical High $1,819.70 | Professional | None | $933.25 | $1,230.27 | $1,819.70 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,412.54 Median $1,819.70 Typical High $2,754.23 | Professional | 50 · Both sides | $1,412.54 | $1,819.70 | $2,754.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $588.84 Median $776.25 Typical High $1,148.15 | Professional | 62 · Two surgeons | $588.84 | $776.25 | $1,148.15 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $151.36 Median $194.98 Typical High $295.12 | Professional | 80 · Assistant surgeon | $151.36 | $194.98 | $295.12 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $131.83 Median $169.82 Typical High $257.04 | Professional | AS · PA/NP assist | $131.83 | $169.82 | $257.04 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $2,238.72 Typical High $2,951.21 | Facility | None | $1,000.00 | $2,238.72 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $1,071.52 Median $1,348.96 Typical High $2,041.74 | Professional | None | $1,071.52 | $1,348.96 | $2,041.74 |
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 $954.99 Median $1,174.90 Typical High $1,698.24 | Professional | None | $954.99 | $1,174.90 | $1,698.24 |
Martin's Point Setting Professional Modifier None Typical Low $1,122.02 Median $1,202.26 Typical High $1,202.26 | Professional | None | $1,122.02 | $1,202.26 | $1,202.26 |
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 $912.01 Median $1,230.27 Typical High $1,584.89 | Professional | None | $912.01 | $1,230.27 | $1,584.89 |
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 $489.78 Median $602.56 Typical High $602.56 | Professional | 52 · Reduced service | $489.78 | $602.56 | $602.56 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $194.98 Median $239.88 Typical High $239.88 | Professional | 53 · Discontinued | $194.98 | $239.88 | $239.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $912.01 Typical High $912.01 | Professional | 54 · Surgery only | $741.31 | $912.01 | $912.01 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $181.97 Typical High $181.97 | Professional | 55 · Aftercare only | $147.91 | $181.97 | $181.97 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $97.72 Median $120.23 Typical High $120.23 | Professional | 56 · Pre-op care only | $97.72 | $120.23 | $120.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $851.14 Typical High $851.14 | Professional | 78 · Unplanned return to OR | $691.83 | $851.14 | $851.14 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $562.34 Median $602.56 Typical High $602.56 | Professional | 52 · Reduced service | $562.34 | $602.56 | $602.56 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $239.88 Typical High $239.88 | Professional | 53 · Discontinued | $223.87 | $239.88 | $239.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $912.01 Typical High $912.01 | Professional | 54 · Surgery only | $851.14 | $912.01 | $912.01 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $181.97 Typical High $181.97 | Professional | 55 · Aftercare only | $169.82 | $181.97 | $181.97 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $120.23 Typical High $120.23 | Professional | 56 · Pre-op care only | $112.20 | $120.23 | $120.23 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $851.14 Typical High $851.14 | Professional | 78 · Unplanned return to OR | $794.33 | $851.14 | $851.14 |
Where Maine sits
The same service costs 16.2 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· 32nd of 51
$1,230
AK $3,890TX $240
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.