How much rates vary
Facilitymedian $2,884 · 10th to 90th $708 to $7,244Professionalmedian $1,000 · 10th to 90th $776 to $1,479
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 $812.83 Median $1,000.00 Typical High $1,380.38 | Professional | None | $812.83 | $1,000.00 | $1,380.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $758.58 Median $977.24 Typical High $1,479.11 | Professional | None | $758.58 | $977.24 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,122.02 Median $1,479.11 Typical High $2,238.72 | Professional | 50 · Both sides | $1,122.02 | $1,479.11 | $2,238.72 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $478.63 Median $616.60 Typical High $933.25 | Professional | 62 · Two surgeons | $478.63 | $616.60 | $933.25 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $120.23 Median $158.49 Typical High $239.88 | Professional | 80 · Assistant surgeon | $120.23 | $158.49 | $239.88 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $104.71 Median $138.04 Typical High $208.93 | Professional | AS · PA/NP assist | $104.71 | $138.04 | $208.93 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $2,238.72 Typical High $2,951.21 | Facility | None | $707.95 | $2,238.72 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $870.96 Median $1,071.52 Typical High $1,584.89 | Professional | None | $870.96 | $1,071.52 | $1,584.89 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,818.38 Median $3,019.95 Typical High $10,232.93 | Facility | None | $2,818.38 | $3,019.95 | $10,232.93 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $776.25 Median $1,023.29 Typical High $1,380.38 | Professional | None | $776.25 | $1,023.29 | $1,380.38 |
Martin's Point Setting Professional Modifier None Typical Low $851.14 Median $1,000.00 Typical High $1,380.38 | Professional | None | $851.14 | $1,000.00 | $1,380.38 |
United Setting Facility Modifier None Typical Low $2,818.38 Median $3,019.95 Typical High $10,232.93 | Facility | None | $2,818.38 | $3,019.95 | $10,232.93 |
United Setting Professional Modifier None Typical Low $758.58 Median $1,023.29 Typical High $1,348.96 | Professional | None | $758.58 | $1,023.29 | $1,348.96 |
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 $398.11 Median $501.19 Typical High $501.19 | Professional | 52 · Reduced service | $398.11 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $199.53 Typical High $199.53 | Professional | 53 · Discontinued | $158.49 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $741.31 Typical High $741.31 | Professional | 54 · Surgery only | $602.56 | $741.31 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $147.91 Typical High $147.91 | Professional | 55 · Aftercare only | $120.23 | $147.91 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $100.00 Typical High $100.00 | Professional | 56 · Pre-op care only | $79.43 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $691.83 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $562.34 | $691.83 | $691.83 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $467.74 Median $501.19 Typical High $501.19 | Professional | 52 · Reduced service | $467.74 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $186.21 Median $199.53 Typical High $199.53 | Professional | 53 · Discontinued | $186.21 | $199.53 | $199.53 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $691.83 Median $741.31 Typical High $741.31 | Professional | 54 · Surgery only | $691.83 | $741.31 | $741.31 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $138.04 Median $147.91 Typical High $147.91 | Professional | 55 · Aftercare only | $138.04 | $147.91 | $147.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $93.33 Median $100.00 Typical High $100.00 | Professional | 56 · Pre-op care only | $93.33 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $645.65 Median $691.83 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $645.65 | $691.83 | $691.83 |
Where Maine sits
The same service costs 4.3 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.
Physician feeFacility fee
AK $9,769TX $2,271
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.