How much rates vary
Facilitymedian $2,754 · 10th to 90th $1,000 to $8,318Professionalmedian $1,479 · 10th to 90th $1,148 to $2,239
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 $1,202.26 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,202.26 | $1,479.11 | $1,479.11 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,148.15 Median $1,479.11 Typical High $2,238.72 | Professional | None | $1,148.15 | $1,479.11 | $2,238.72 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,698.24 Median $2,238.72 Typical High $3,388.44 | Professional | 50 · Both sides | $1,698.24 | $2,238.72 | $3,388.44 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $724.44 Median $933.25 Typical High $1,412.54 | Professional | 62 · Two surgeons | $724.44 | $933.25 | $1,412.54 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $181.97 Median $239.88 Typical High $354.81 | Professional | 80 · Assistant surgeon | $181.97 | $239.88 | $354.81 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $158.49 Median $208.93 Typical High $316.23 | Professional | AS · PA/NP assist | $158.49 | $208.93 | $316.23 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $5,754.40 Typical High $9,120.11 | Facility | None | $1,000.00 | $5,754.40 | $9,120.11 |
Cigna Setting Professional Modifier None Typical Low $1,318.26 Median $1,621.81 Typical High $2,454.71 | Professional | None | $1,318.26 | $1,621.81 | $2,454.71 |
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 $1,148.15 Median $1,445.44 Typical High $2,041.74 | Professional | None | $1,148.15 | $1,445.44 | $2,041.74 |
Martin's Point Setting Professional Modifier None Typical Low $1,230.27 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,230.27 | $1,479.11 | $1,479.11 |
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 $1,122.02 Median $1,513.56 Typical High $1,949.84 | Professional | None | $1,122.02 | $1,513.56 | $1,949.84 |
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 $602.56 Median $741.31 Typical High $741.31 | Professional | 52 · Reduced service | $602.56 | $741.31 | $741.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $295.12 Typical High $295.12 | Professional | 53 · Discontinued | $239.88 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $1,096.48 Typical High $1,096.48 | Professional | 54 · Surgery only | $912.01 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $181.97 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $147.91 Typical High $147.91 | Professional | 56 · Pre-op care only | $120.23 | $147.91 | $147.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $1,023.29 Typical High $1,023.29 | Professional | 78 · Unplanned return to OR | $851.14 | $1,023.29 | $1,023.29 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $691.83 Median $741.31 Typical High $741.31 | Professional | 52 · Reduced service | $691.83 | $741.31 | $741.31 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $275.42 Median $295.12 Typical High $295.12 | Professional | 53 · Discontinued | $275.42 | $295.12 | $295.12 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,096.48 Typical High $1,096.48 | Professional | 54 · Surgery only | $1,023.29 | $1,096.48 | $1,096.48 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $204.17 | $218.78 | $218.78 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $138.04 Median $147.91 Typical High $147.91 | Professional | 56 · Pre-op care only | $138.04 | $147.91 | $147.91 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $1,023.29 Typical High $1,023.29 | Professional | 78 · Unplanned return to OR | $954.99 | $1,023.29 | $1,023.29 |
Where Maine sits
The same service costs 8.3 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· 33rd of 51
$1,479
AK $4,786TX $575
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.