How much rates vary
Facilitymedian $2,239 · 10th to 90th $1,000 to $3,890Professionalmedian $1,479 · 10th to 90th $1,122 to $2,138
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 $1,174.90 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,174.90 | $1,479.11 | $1,479.11 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,096.48 Median $1,445.44 Typical High $2,137.96 | Professional | None | $1,096.48 | $1,445.44 | $2,137.96 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,659.59 Median $2,137.96 Typical High $3,235.94 | Professional | 50 · Both sides | $1,659.59 | $2,137.96 | $3,235.94 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $691.83 Median $912.01 Typical High $1,348.96 | Professional | 62 · Two surgeons | $691.83 | $912.01 | $1,348.96 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $177.83 Median $229.09 Typical High $346.74 | Professional | 80 · Assistant surgeon | $177.83 | $229.09 | $346.74 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $154.88 Median $199.53 Typical High $302.00 | Professional | AS · PA/NP assist | $154.88 | $199.53 | $302.00 |
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 $1,288.25 Median $1,621.81 Typical High $2,344.23 | Professional | None | $1,288.25 | $1,621.81 | $2,344.23 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,122.02 Median $1,445.44 Typical High $1,995.26 | Professional | None | $1,122.02 | $1,445.44 | $1,995.26 |
Martin's Point Setting Professional Modifier None Typical Low $1,380.38 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,380.38 | $1,479.11 | $1,479.11 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
United Setting Professional Modifier None Typical Low $1,096.48 Median $1,445.44 Typical High $1,949.84 | Professional | None | $1,096.48 | $1,445.44 | $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 $588.84 Median $741.31 Typical High $741.31 | Professional | 52 · Reduced service | $588.84 | $741.31 | $741.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $234.42 Median $295.12 Typical High $295.12 | Professional | 53 · Discontinued | $234.42 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $891.25 Median $1,096.48 Typical High $1,096.48 | Professional | 54 · Surgery only | $891.25 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $177.83 Median $223.87 Typical High $223.87 | Professional | 55 · Aftercare only | $177.83 | $223.87 | $223.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $117.49 Median $147.91 Typical High $147.91 | Professional | 56 · Pre-op care only | $117.49 | $147.91 | $147.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $831.76 Median $1,023.29 Typical High $1,023.29 | Professional | 78 · Unplanned return to OR | $831.76 | $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 $223.87 Typical High $223.87 | Professional | 55 · Aftercare only | $204.17 | $223.87 | $223.87 |
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 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· 31st of 51
$1,479
AK $4,571TX $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.