How much rates vary
Facilitymedian $26,915 · 10th to 90th $776 to $27,542Professionalmedian $4,677 · 10th to 90th $3,548 to $6,918
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 $3,801.89 Median $4,265.80 Typical High $4,365.16 | Professional | None | $3,801.89 | $4,265.80 | $4,365.16 |
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 $3,467.37 Median $4,786.30 Typical High $7,585.78 | Professional | None | $3,467.37 | $4,786.30 | $7,585.78 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,187.76 Median $2,818.38 Typical High $4,265.80 | Professional | 62 · Two surgeons | $2,187.76 | $2,818.38 | $4,265.80 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $549.54 Median $707.95 Typical High $1,096.48 | Professional | 80 · Assistant surgeon | $549.54 | $707.95 | $1,096.48 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $478.63 Median $630.96 Typical High $954.99 | Professional | AS · PA/NP assist | $478.63 | $630.96 | $954.99 |
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 $3,235.94 Median $5,128.61 Typical High $7,762.47 | Professional | None | $3,235.94 | $5,128.61 | $7,762.47 |
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 $3,630.78 Median $4,786.30 Typical High $6,918.31 | Professional | None | $3,630.78 | $4,786.30 | $6,918.31 |
Martin's Point Setting Professional Modifier None Typical Low $4,073.80 Median $4,265.80 Typical High $4,265.80 | Professional | None | $4,073.80 | $4,265.80 | $4,265.80 |
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 $3,548.13 Median $5,011.87 Typical High $6,918.31 | Professional | None | $3,548.13 | $5,011.87 | $6,918.31 |
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 $1,905.46 Median $2,137.96 Typical High $2,187.76 | Professional | 52 · Reduced service | $1,905.46 | $2,137.96 | $2,187.76 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $758.58 Median $851.14 Typical High $870.96 | Professional | 53 · Discontinued | $758.58 | $851.14 | $870.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,884.03 Median $3,235.94 Typical High $3,235.94 | Professional | 54 · Surgery only | $2,884.03 | $3,235.94 | $3,235.94 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $575.44 Median $645.65 Typical High $645.65 | Professional | 55 · Aftercare only | $575.44 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $380.19 Median $426.58 Typical High $436.52 | Professional | 56 · Pre-op care only | $380.19 | $426.58 | $436.52 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,691.53 Median $3,019.95 Typical High $3,019.95 | Professional | 78 · Unplanned return to OR | $2,691.53 | $3,019.95 | $3,019.95 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2,041.74 Median $2,137.96 Typical High $2,137.96 | Professional | 52 · Reduced service | $2,041.74 | $2,137.96 | $2,137.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $812.83 Median $851.14 Typical High $851.14 | Professional | 53 · Discontinued | $812.83 | $851.14 | $851.14 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $3,090.30 Median $3,235.94 Typical High $3,235.94 | Professional | 54 · Surgery only | $3,090.30 | $3,235.94 | $3,235.94 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $616.60 Median $645.65 Typical High $645.65 | Professional | 55 · Aftercare only | $616.60 | $645.65 | $645.65 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $407.38 Median $426.58 Typical High $426.58 | Professional | 56 · Pre-op care only | $407.38 | $426.58 | $426.58 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,884.03 Median $3,019.95 Typical High $3,019.95 | Professional | 78 · Unplanned return to OR | $2,884.03 | $3,019.95 | $3,019.95 |
Where Maine sits
The same service costs 21.9 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· 21st of 51
$4,786
AK $12,303TX $562
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.