How much rates vary
Facilitymedian $26,303 · 10th to 90th $776 to $26,915Professionalmedian $1,950 · 10th to 90th $1,380 to $2,630
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $1,412.54 Median $1,698.24 Typical High $2,137.96 | Professional | None | $1,412.54 | $1,698.24 | $2,137.96 |
Anthem BCBS Setting Facility Modifier None Typical Low $20,892.96 Median $26,915.35 Typical High $27,542.29 | Facility | None | $20,892.96 | $26,915.35 | $27,542.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,318.26 Median $1,949.84 Typical High $2,630.27 | Professional | None | $1,318.26 | $1,949.84 | $2,630.27 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $831.76 Median $1,230.27 Typical High $1,659.59 | Professional | 62 · Two surgeons | $831.76 | $1,230.27 | $1,659.59 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $208.93 Median $316.23 Typical High $416.87 | Professional | 80 · Assistant surgeon | $208.93 | $316.23 | $416.87 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $186.21 Median $275.42 Typical High $371.54 | Professional | AS · PA/NP assist | $186.21 | $275.42 | $371.54 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $707.95 Typical High $2,290.87 | Facility | None | $151.36 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,778.28 Median $1,819.70 Typical High $3,019.95 | Professional | None | $1,778.28 | $1,819.70 | $3,019.95 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,621.81 Median $2,041.74 Typical High $2,691.53 | Professional | None | $1,621.81 | $2,041.74 | $2,691.53 |
Martin's Point Setting Professional Modifier None Typical Low $1,412.54 Median $1,698.24 Typical High $2,137.96 | Professional | None | $1,412.54 | $1,698.24 | $2,137.96 |
United Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $1,380.38 Median $2,187.76 Typical High $2,691.53 | Professional | None | $1,380.38 | $2,187.76 | $2,691.53 |
6 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 $851.14 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $851.14 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $338.84 Typical High $338.84 | Professional | 53 · Discontinued | $338.84 | $338.84 | $338.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $1,258.93 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,258.93 | $1,258.93 | $1,258.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $257.04 Typical High $257.04 | Professional | 55 · Aftercare only | $257.04 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $169.82 Typical High $169.82 | Professional | 56 · Pre-op care only | $169.82 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $1,174.90 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,174.90 | $1,174.90 | $1,174.90 |
Where Maine sits
The same service costs 13.5 times more in Maine than in Washington. 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
ME $28,253WA $2,096
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.