How much rates vary
Facilitymedian $26,915 · 10th to 90th $776 to $27,542Professionalmedian $2,042 · 10th to 90th $1,585 to $2,951
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 $1,778.28 Median $1,905.46 Typical High $2,398.83 | Professional | None | $1,778.28 | $1,905.46 | $2,398.83 |
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 $1,513.56 Median $2,187.76 Typical High $3,311.31 | Professional | None | $1,513.56 | $2,187.76 | $3,311.31 |
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 $478.63 | Professional | 80 · Assistant surgeon | $239.88 | $316.23 | $478.63 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $213.80 Median $275.42 Typical High $416.87 | Professional | AS · PA/NP assist | $213.80 | $275.42 | $416.87 |
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 $1,862.09 Median $2,238.72 Typical High $3,388.44 | Professional | None | $1,862.09 | $2,238.72 | $3,388.44 |
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 $1,584.89 Median $2,137.96 Typical High $3,019.95 | Professional | None | $1,584.89 | $2,137.96 | $3,019.95 |
Martin's Point Setting Professional Modifier None Typical Low $1,862.09 Median $1,905.46 Typical High $2,398.83 | Professional | None | $1,862.09 | $1,905.46 | $2,398.83 |
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 $1,548.82 Median $2,187.76 Typical High $3,019.95 | Professional | None | $1,548.82 | $2,187.76 | $3,019.95 |
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 $851.14 Median $933.25 Typical High $954.99 | Professional | 52 · Reduced service | $851.14 | $933.25 | $954.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $380.19 Typical High $380.19 | Professional | 53 · Discontinued | $338.84 | $380.19 | $380.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $1,412.54 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,258.93 | $1,412.54 | $1,412.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $281.84 Typical High $281.84 | Professional | 55 · Aftercare only | $257.04 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $190.55 Typical High $190.55 | Professional | 56 · Pre-op care only | $169.82 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $1,318.26 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,174.90 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $912.01 Median $933.25 Typical High $933.25 | Professional | 52 · Reduced service | $912.01 | $933.25 | $933.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $363.08 Median $380.19 Typical High $380.19 | Professional | 53 · Discontinued | $363.08 | $380.19 | $380.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,348.96 Median $1,412.54 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,348.96 | $1,412.54 | $1,412.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $281.84 Typical High $281.84 | Professional | 55 · Aftercare only | $269.15 | $281.84 | $281.84 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $181.97 Median $190.55 Typical High $190.55 | Professional | 56 · Pre-op care only | $181.97 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $1,318.26 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,258.93 | $1,318.26 | $1,318.26 |
Where Maine sits
The same service costs 5.4 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· 24th of 51
$2,138
AK $5,623TX $1,047
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.