How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $1,995 · 10th to 90th $1,479 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 $1,513.56 Median $1,819.70 Typical High $1,819.70 | Professional | None | $1,513.56 | $1,819.70 | $1,819.70 |
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 $1,479.11 Median $2,041.74 Typical High $3,090.30 | Professional | None | $1,479.11 | $2,041.74 | $3,090.30 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $933.25 Median $1,202.26 Typical High $1,819.70 | Professional | 62 · Two surgeons | $933.25 | $1,202.26 | $1,819.70 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $239.88 Median $309.03 Typical High $467.74 | Professional | 80 · Assistant surgeon | $239.88 | $309.03 | $467.74 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $208.93 Median $269.15 Typical High $407.38 | Professional | AS · PA/NP assist | $208.93 | $269.15 | $407.38 |
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 $1,621.81 Median $2,187.76 Typical High $3,311.31 | Professional | None | $1,621.81 | $2,187.76 | $3,311.31 |
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 $1,513.56 Median $2,041.74 Typical High $2,951.21 | Professional | None | $1,513.56 | $2,041.74 | $2,951.21 |
Martin's Point Setting Professional Modifier None Typical Low $1,778.28 Median $1,819.70 Typical High $1,819.70 | Professional | None | $1,778.28 | $1,819.70 | $1,819.70 |
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 $1,479.11 Median $2,137.96 Typical High $2,951.21 | Professional | None | $1,479.11 | $2,137.96 | $2,951.21 |
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 $758.58 Median $912.01 Typical High $912.01 | Professional | 52 · Reduced service | $758.58 | $912.01 | $912.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $363.08 Typical High $363.08 | Professional | 53 · Discontinued | $302.00 | $363.08 | $363.08 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $1,380.38 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,148.15 | $1,380.38 | $1,380.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $275.42 Typical High $275.42 | Professional | 55 · Aftercare only | $229.09 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $181.97 Typical High $181.97 | Professional | 56 · Pre-op care only | $151.36 | $181.97 | $181.97 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,288.25 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,288.25 | $1,288.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $891.25 Median $912.01 Typical High $912.01 | Professional | 52 · Reduced service | $891.25 | $912.01 | $912.01 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $354.81 Median $363.08 Typical High $363.08 | Professional | 53 · Discontinued | $354.81 | $363.08 | $363.08 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,318.26 Median $1,380.38 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,318.26 | $1,380.38 | $1,380.38 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $275.42 Typical High $275.42 | Professional | 55 · Aftercare only | $269.15 | $275.42 | $275.42 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $177.83 Median $181.97 Typical High $181.97 | Professional | 56 · Pre-op care only | $177.83 | $181.97 | $181.97 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,230.27 Median $1,288.25 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,230.27 | $1,288.25 | $1,288.25 |
Where Maine sits
The same service costs 20.9 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
$2,042
AK $5,129TX $245
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.