How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $2,239 · 10th to 90th $1,660 to $3,236
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 $1,698.24 Median $2,041.74 Typical High $2,041.74 | Professional | None | $1,698.24 | $2,041.74 | $2,041.74 |
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 $1,659.59 Median $2,290.87 Typical High $3,467.37 | Professional | None | $1,659.59 | $2,290.87 | $3,467.37 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,047.13 Median $1,348.96 Typical High $2,041.74 | Professional | 62 · Two surgeons | $1,047.13 | $1,348.96 | $2,041.74 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $263.03 Median $346.74 Typical High $524.81 | Professional | 80 · Assistant surgeon | $263.03 | $346.74 | $524.81 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $234.42 Median $302.00 Typical High $457.09 | Professional | AS · PA/NP assist | $234.42 | $302.00 | $457.09 |
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 $2,454.71 Typical High $3,715.35 | Professional | None | $1,862.09 | $2,454.71 | $3,715.35 |
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 $1,698.24 Median $2,290.87 Typical High $3,235.94 | Professional | None | $1,698.24 | $2,290.87 | $3,235.94 |
Martin's Point Setting Professional Modifier None Typical Low $1,698.24 Median $2,041.74 Typical High $2,041.74 | Professional | None | $1,698.24 | $2,041.74 | $2,041.74 |
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 $1,659.59 Median $2,344.23 Typical High $3,311.31 | Professional | None | $1,659.59 | $2,344.23 | $3,311.31 |
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 $851.14 Median $1,023.29 Typical High $1,023.29 | Professional | 52 · Reduced service | $851.14 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $407.38 Typical High $407.38 | Professional | 53 · Discontinued | $338.84 | $407.38 | $407.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,288.25 Median $1,548.82 Typical High $1,548.82 | Professional | 54 · Surgery only | $1,288.25 | $1,548.82 | $1,548.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $309.03 Typical High $309.03 | Professional | 55 · Aftercare only | $257.04 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $204.17 Typical High $204.17 | Professional | 56 · Pre-op care only | $169.82 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $1,445.44 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $1,202.26 | $1,445.44 | $1,445.44 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $851.14 Median $1,023.29 Typical High $1,023.29 | Professional | 52 · Reduced service | $851.14 | $1,023.29 | $1,023.29 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $407.38 Typical High $407.38 | Professional | 53 · Discontinued | $338.84 | $407.38 | $407.38 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,288.25 Median $1,548.82 Typical High $1,548.82 | Professional | 54 · Surgery only | $1,288.25 | $1,548.82 | $1,548.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $309.03 Typical High $309.03 | Professional | 55 · Aftercare only | $257.04 | $309.03 | $309.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $204.17 Typical High $204.17 | Professional | 56 · Pre-op care only | $169.82 | $204.17 | $204.17 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $1,445.44 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $1,202.26 | $1,445.44 | $1,445.44 |
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· 21st of 51
$2,291
AK $5,888TX $1,096
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.