How much rates vary
Facilitymedian $26,915 · 10th to 90th $776 to $27,542Professionalmedian $1,698 · 10th to 90th $1,288 to $2,570
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 $1,348.96 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,348.96 | $1,548.82 | $1,548.82 |
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 $1,258.93 Median $1,737.80 Typical High $2,818.38 | Professional | None | $1,258.93 | $1,737.80 | $2,818.38 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $794.33 Median $1,047.13 Typical High $1,584.89 | Professional | 62 · Two surgeons | $794.33 | $1,047.13 | $1,584.89 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $204.17 Median $263.03 Typical High $407.38 | Professional | 80 · Assistant surgeon | $204.17 | $263.03 | $407.38 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $177.83 Median $229.09 Typical High $354.81 | Professional | AS · PA/NP assist | $177.83 | $229.09 | $354.81 |
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 $1,479.11 Median $1,862.09 Typical High $2,884.03 | Professional | None | $1,479.11 | $1,862.09 | $2,884.03 |
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 $1,318.26 Median $1,819.70 Typical High $2,570.40 | Professional | None | $1,318.26 | $1,819.70 | $2,570.40 |
Martin's Point Setting Professional Modifier None Typical Low $1,513.56 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,513.56 | $1,548.82 | $1,548.82 |
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 $1,288.25 Median $1,819.70 Typical High $2,570.40 | Professional | None | $1,288.25 | $1,819.70 | $2,570.40 |
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 $676.08 Median $776.25 Typical High $776.25 | Professional | 52 · Reduced service | $676.08 | $776.25 | $776.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $275.42 Median $309.03 Typical High $309.03 | Professional | 53 · Discontinued | $275.42 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,174.90 Typical High $1,174.90 | Professional | 54 · Surgery only | $1,023.29 | $1,174.90 | $1,174.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $234.42 Typical High $234.42 | Professional | 55 · Aftercare only | $204.17 | $234.42 | $234.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $154.88 Typical High $154.88 | Professional | 56 · Pre-op care only | $134.90 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $1,096.48 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $954.99 | $1,096.48 | $1,096.48 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $758.58 Median $776.25 Typical High $776.25 | Professional | 52 · Reduced service | $758.58 | $776.25 | $776.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $309.03 Typical High $309.03 | Professional | 53 · Discontinued | $302.00 | $309.03 | $309.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $1,174.90 Typical High $1,174.90 | Professional | 54 · Surgery only | $1,148.15 | $1,174.90 | $1,174.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $234.42 Typical High $234.42 | Professional | 55 · Aftercare only | $229.09 | $234.42 | $234.42 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $154.88 Typical High $154.88 | Professional | 56 · Pre-op care only | $151.36 | $154.88 | $154.88 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,096.48 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,096.48 | $1,096.48 |
Where Maine sits
The same service costs 21.4 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· 22nd of 51
$1,778
AK $4,571TX $214
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.