How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $2,399 · 10th to 90th $1,738 to $3,981
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 $2,398.83 Median $2,398.83 Typical High $3,235.94 | Professional | None | $2,398.83 | $2,398.83 | $3,235.94 |
Anthem BCBS Setting Facility Modifier None Typical Low $12,589.25 Median $16,218.10 Typical High $16,982.44 | Facility | None | $12,589.25 | $16,218.10 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,548.82 Median $2,041.74 Typical High $2,344.23 | Professional | None | $1,548.82 | $2,041.74 | $2,344.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $977.24 Median $1,288.25 Typical High $1,479.11 | Professional | 62 · Two surgeons | $977.24 | $1,288.25 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $245.47 Median $331.13 Typical High $380.19 | Professional | 80 · Assistant surgeon | $245.47 | $331.13 | $380.19 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $213.80 Median $288.40 Typical High $331.13 | Professional | AS · PA/NP assist | $213.80 | $288.40 | $331.13 |
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 $2,344.23 Median $3,090.30 Typical High $4,466.84 | Professional | None | $2,344.23 | $3,090.30 | $4,466.84 |
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 $2,089.30 Median $2,818.38 Typical High $4,073.80 | Professional | None | $2,089.30 | $2,818.38 | $4,073.80 |
Martin's Point Setting Professional Modifier None Typical Low $2,398.83 Median $2,398.83 Typical High $2,630.27 | Professional | None | $2,398.83 | $2,398.83 | $2,630.27 |
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 $1,995.26 Median $2,754.23 Typical High $4,365.16 | Professional | None | $1,995.26 | $2,754.23 | $4,365.16 |
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 $1,174.90 Median $1,174.90 Typical High $1,621.81 | Professional | 52 · Reduced service | $1,174.90 | $1,174.90 | $1,621.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $478.63 Median $478.63 Typical High $645.65 | Professional | 53 · Discontinued | $478.63 | $478.63 | $645.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,778.28 Median $1,778.28 Typical High $2,398.83 | Professional | 54 · Surgery only | $1,778.28 | $1,778.28 | $2,398.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $354.81 Median $354.81 Typical High $478.63 | Professional | 55 · Aftercare only | $354.81 | $354.81 | $478.63 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $239.88 Median $239.88 Typical High $323.59 | Professional | 56 · Pre-op care only | $239.88 | $239.88 | $323.59 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,659.59 Median $1,659.59 Typical High $2,238.72 | Professional | 78 · Unplanned return to OR | $1,659.59 | $1,659.59 | $2,238.72 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,174.90 Median $1,174.90 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,174.90 | $1,174.90 | $1,318.26 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $478.63 Median $478.63 Typical High $524.81 | Professional | 53 · Discontinued | $478.63 | $478.63 | $524.81 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,778.28 Median $1,778.28 Typical High $1,995.26 | Professional | 54 · Surgery only | $1,778.28 | $1,778.28 | $1,995.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $354.81 Median $354.81 Typical High $398.11 | Professional | 55 · Aftercare only | $354.81 | $354.81 | $398.11 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $239.88 Median $239.88 Typical High $263.03 | Professional | 56 · Pre-op care only | $239.88 | $239.88 | $263.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,659.59 Median $1,659.59 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $1,659.59 | $1,659.59 | $1,862.09 |
Where Maine sits
The same service costs 9.8 times more in Alaska than in Kentucky. 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· 30th of 51
$2,399
AK $8,511KY $871
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.