How much rates vary
Facilitymedian $2,239 · 10th to 90th $813 to $3,890Professionalmedian $661 · 10th to 90th $513 to $1,023
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 $524.81 Median $660.69 Typical High $660.69 | Professional | None | $524.81 | $660.69 | $660.69 |
Anthem BCBS Setting Professional Modifier None Typical Low $512.86 Median $676.08 Typical High $1,023.29 | Professional | None | $512.86 | $676.08 | $1,023.29 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $776.25 Median $1,000.00 Typical High $1,513.56 | Professional | 50 · Both sides | $776.25 | $1,000.00 | $1,513.56 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $323.59 Median $426.58 Typical High $645.65 | Professional | 62 · Two surgeons | $323.59 | $426.58 | $645.65 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $83.18 Median $107.15 Typical High $162.18 | Professional | 80 · Assistant surgeon | $83.18 | $107.15 | $162.18 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $72.44 Median $93.33 Typical High $141.25 | Professional | AS · PA/NP assist | $72.44 | $93.33 | $141.25 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $2,238.72 Typical High $2,951.21 | Facility | None | $812.83 | $2,238.72 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $602.56 Median $741.31 Typical High $1,071.52 | Professional | None | $602.56 | $741.31 | $1,071.52 |
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 $512.86 Median $645.65 Typical High $977.24 | Professional | None | $512.86 | $645.65 | $977.24 |
Martin's Point Setting Professional Modifier None Typical Low $524.81 Median $660.69 Typical High $660.69 | Professional | None | $524.81 | $660.69 | $660.69 |
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 $501.19 Median $645.65 Typical High $870.96 | Professional | None | $501.19 | $645.65 | $870.96 |
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 $269.15 Median $331.13 Typical High $331.13 | Professional | 52 · Reduced service | $269.15 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $107.15 Median $131.83 Typical High $131.83 | Professional | 53 · Discontinued | $107.15 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $398.11 Median $501.19 Typical High $501.19 | Professional | 54 · Surgery only | $398.11 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $81.28 Median $100.00 Typical High $100.00 | Professional | 55 · Aftercare only | $81.28 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $53.70 Median $66.07 Typical High $66.07 | Professional | 56 · Pre-op care only | $53.70 | $66.07 | $66.07 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $371.54 Median $467.74 Typical High $467.74 | Professional | 78 · Unplanned return to OR | $371.54 | $467.74 | $467.74 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $316.23 Median $331.13 Typical High $331.13 | Professional | 52 · Reduced service | $316.23 | $331.13 | $331.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $125.89 Median $131.83 Typical High $131.83 | Professional | 53 · Discontinued | $125.89 | $131.83 | $131.83 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $467.74 Median $501.19 Typical High $501.19 | Professional | 54 · Surgery only | $467.74 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $93.33 Median $100.00 Typical High $100.00 | Professional | 55 · Aftercare only | $93.33 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $63.10 Median $66.07 Typical High $66.07 | Professional | 56 · Pre-op care only | $63.10 | $66.07 | $66.07 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $436.52 Median $467.74 Typical High $467.74 | Professional | 78 · Unplanned return to OR | $436.52 | $467.74 | $467.74 |
Where Maine sits
The same service costs 4.5 times more in Connecticut than in Montana. 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
CT $7,632MT $1,703
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.