How much rates vary
Facilitymedian $2,692 · 10th to 90th $708 to $6,310Professionalmedian $1,950 · 10th to 90th $1,479 to $2,951
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 $1,584.89 Median $1,949.84 Typical High $1,949.84 | Professional | None | $1,584.89 | $1,949.84 | $1,949.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,513.56 Median $1,949.84 Typical High $2,951.21 | Professional | None | $1,513.56 | $1,949.84 | $2,951.21 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $2,238.72 Median $2,951.21 Typical High $4,365.16 | Professional | 50 · Both sides | $2,238.72 | $2,951.21 | $4,365.16 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $954.99 Median $1,230.27 Typical High $1,862.09 | Professional | 62 · Two surgeons | $954.99 | $1,230.27 | $1,862.09 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $239.88 Median $316.23 Typical High $467.74 | Professional | 80 · Assistant surgeon | $239.88 | $316.23 | $467.74 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $208.93 Median $275.42 Typical High $407.38 | Professional | AS · PA/NP assist | $208.93 | $275.42 | $407.38 |
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 $1,479.11 Median $2,137.96 Typical High $3,090.30 | Professional | None | $1,479.11 | $2,137.96 | $3,090.30 |
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 $1,479.11 Median $1,905.46 Typical High $2,691.53 | Professional | None | $1,479.11 | $1,905.46 | $2,691.53 |
Martin's Point Setting Professional Modifier None Typical Low $1,819.70 Median $1,949.84 Typical High $1,949.84 | Professional | None | $1,819.70 | $1,949.84 | $1,949.84 |
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 $1,318.26 Median $1,905.46 Typical High $2,570.40 | Professional | None | $1,318.26 | $1,905.46 | $2,570.40 |
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 $794.33 Median $977.24 Typical High $977.24 | Professional | 52 · Reduced service | $794.33 | $977.24 | $977.24 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $389.05 Typical High $389.05 | Professional | 53 · Discontinued | $316.23 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,445.44 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,202.26 | $1,445.44 | $1,445.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $239.88 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $194.98 Typical High $194.98 | Professional | 56 · Pre-op care only | $158.49 | $194.98 | $194.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,348.96 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,348.96 | $1,348.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $912.01 Median $977.24 Typical High $977.24 | Professional | 52 · Reduced service | $912.01 | $977.24 | $977.24 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $363.08 Median $389.05 Typical High $389.05 | Professional | 53 · Discontinued | $363.08 | $389.05 | $389.05 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,348.96 Median $1,445.44 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,348.96 | $1,445.44 | $1,445.44 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $269.15 | $288.40 | $288.40 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $181.97 Median $194.98 Typical High $194.98 | Professional | 56 · Pre-op care only | $181.97 | $194.98 | $194.98 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $1,348.96 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,258.93 | $1,348.96 | $1,348.96 |
Where Maine sits
The same service costs 8.5 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· 25th of 51
$1,950
AK $6,166TX $724
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.