How much rates vary
Facilitymedian $26,915 · 10th to 90th $776 to $27,542Professionalmedian $3,467 · 10th to 90th $2,692 to $5,248
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 $2,951.21 Median $3,311.31 Typical High $3,311.31 | Professional | None | $2,951.21 | $3,311.31 | $3,311.31 |
Anthem BCBS Setting Facility Modifier None Typical Low $21,379.62 Median $26,915.35 Typical High $28,183.83 | Facility | None | $21,379.62 | $26,915.35 | $28,183.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $2,630.27 Median $3,630.78 Typical High $5,370.32 | Professional | None | $2,630.27 | $3,630.78 | $5,370.32 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,659.59 Median $2,137.96 Typical High $3,311.31 | Professional | 62 · Two surgeons | $1,659.59 | $2,137.96 | $3,311.31 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $426.58 Median $549.54 Typical High $831.76 | Professional | 80 · Assistant surgeon | $426.58 | $549.54 | $831.76 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $371.54 Median $478.63 Typical High $724.44 | Professional | AS · PA/NP assist | $371.54 | $478.63 | $724.44 |
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 $2,754.23 Median $3,630.78 Typical High $6,025.60 | Professional | None | $2,754.23 | $3,630.78 | $6,025.60 |
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 $2,818.38 Median $3,548.13 Typical High $5,128.61 | Professional | None | $2,818.38 | $3,548.13 | $5,128.61 |
Martin's Point Setting Professional Modifier None Typical Low $3,235.94 Median $3,311.31 Typical High $3,311.31 | Professional | None | $3,235.94 | $3,311.31 | $3,311.31 |
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 $2,691.53 Median $3,890.45 Typical High $5,495.41 | Professional | None | $2,691.53 | $3,890.45 | $5,495.41 |
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 $1,479.11 Median $1,659.59 Typical High $1,659.59 | Professional | 52 · Reduced service | $1,479.11 | $1,659.59 | $1,659.59 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $588.84 Median $660.69 Typical High $660.69 | Professional | 53 · Discontinued | $588.84 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,187.76 Median $2,511.89 Typical High $2,511.89 | Professional | 54 · Surgery only | $2,187.76 | $2,511.89 | $2,511.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $436.52 Median $501.19 Typical High $501.19 | Professional | 55 · Aftercare only | $436.52 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $295.12 Median $331.13 Typical High $331.13 | Professional | 56 · Pre-op care only | $295.12 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,041.74 Median $2,344.23 Typical High $2,344.23 | Professional | 78 · Unplanned return to OR | $2,041.74 | $2,344.23 | $2,344.23 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,621.81 Median $1,659.59 Typical High $1,659.59 | Professional | 52 · Reduced service | $1,621.81 | $1,659.59 | $1,659.59 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $645.65 Median $660.69 Typical High $660.69 | Professional | 53 · Discontinued | $645.65 | $660.69 | $660.69 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,454.71 Median $2,511.89 Typical High $2,511.89 | Professional | 54 · Surgery only | $2,454.71 | $2,511.89 | $2,511.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $489.78 Median $501.19 Typical High $501.19 | Professional | 55 · Aftercare only | $489.78 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $323.59 Median $331.13 Typical High $331.13 | Professional | 56 · Pre-op care only | $323.59 | $331.13 | $331.13 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,290.87 Median $2,344.23 Typical High $2,344.23 | Professional | 78 · Unplanned return to OR | $2,290.87 | $2,344.23 | $2,344.23 |
Where Maine sits
The same service costs 22.9 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· 20th of 51
$3,631
AK $9,120TX $398
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.