How much rates vary
Facilitymedian $2,239 · 10th to 90th $1,000 to $3,890Professionalmedian $741 · 10th to 90th $575 to $1,148
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 $602.56 Median $741.31 Typical High $741.31 | Professional | None | $602.56 | $741.31 | $741.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $588.84 Median $758.58 Typical High $1,148.15 | Professional | None | $588.84 | $758.58 | $1,148.15 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $870.96 Median $1,148.15 Typical High $1,737.80 | Professional | 50 · Both sides | $870.96 | $1,148.15 | $1,737.80 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $371.54 Median $478.63 Typical High $724.44 | Professional | 62 · Two surgeons | $371.54 | $478.63 | $724.44 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $93.33 Median $123.03 Typical High $181.97 | Professional | 80 · Assistant surgeon | $93.33 | $123.03 | $181.97 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $81.28 Median $107.15 Typical High $162.18 | Professional | AS · PA/NP assist | $81.28 | $107.15 | $162.18 |
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 $676.08 Median $831.76 Typical High $1,202.26 | Professional | None | $676.08 | $831.76 | $1,202.26 |
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 $562.34 Median $724.44 Typical High $1,096.48 | Professional | None | $562.34 | $724.44 | $1,096.48 |
Martin's Point Setting Professional Modifier None Typical Low $691.83 Median $741.31 Typical High $741.31 | Professional | None | $691.83 | $741.31 | $741.31 |
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 $562.34 Median $724.44 Typical High $977.24 | Professional | None | $562.34 | $724.44 | $977.24 |
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 $302.00 Median $371.54 Typical High $371.54 | Professional | 52 · Reduced service | $302.00 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $120.23 Median $147.91 Typical High $147.91 | Professional | 53 · Discontinued | $120.23 | $147.91 | $147.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $457.09 Median $549.54 Typical High $549.54 | Professional | 54 · Surgery only | $457.09 | $549.54 | $549.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $91.20 Median $112.20 Typical High $112.20 | Professional | 55 · Aftercare only | $91.20 | $112.20 | $112.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $60.26 Median $74.13 Typical High $74.13 | Professional | 56 · Pre-op care only | $60.26 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $426.58 Median $512.86 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $426.58 | $512.86 | $512.86 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $346.74 Median $371.54 Typical High $371.54 | Professional | 52 · Reduced service | $346.74 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $141.25 Median $147.91 Typical High $147.91 | Professional | 53 · Discontinued | $141.25 | $147.91 | $147.91 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $524.81 Median $549.54 Typical High $549.54 | Professional | 54 · Surgery only | $524.81 | $549.54 | $549.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $104.71 Median $112.20 Typical High $112.20 | Professional | 55 · Aftercare only | $104.71 | $112.20 | $112.20 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $69.18 Median $74.13 Typical High $74.13 | Professional | 56 · Pre-op care only | $69.18 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $489.78 Median $512.86 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $489.78 | $512.86 | $512.86 |
Where Maine sits
The same service costs 14.1 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
$741
AK $2,455TX $174
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.