How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $2,291 · 10th to 90th $1,738 to $3,311
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 $2,089.30 Typical High $3,162.28 | Professional | None | $1,778.28 | $2,089.30 | $3,162.28 |
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 $1,698.24 Median $2,290.87 Typical High $3,311.31 | Professional | None | $1,698.24 | $2,290.87 | $3,311.31 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,071.52 Median $1,380.38 Typical High $2,089.30 | Professional | 62 · Two surgeons | $1,071.52 | $1,380.38 | $2,089.30 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $275.42 Median $354.81 Typical High $537.03 | Professional | 80 · Assistant surgeon | $275.42 | $354.81 | $537.03 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $239.88 Median $309.03 Typical High $467.74 | Professional | AS · PA/NP assist | $239.88 | $309.03 | $467.74 |
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 $1,819.70 Median $2,511.89 Typical High $3,801.89 | Professional | None | $1,819.70 | $2,511.89 | $3,801.89 |
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 $1,737.80 Median $2,344.23 Typical High $3,388.44 | Professional | None | $1,737.80 | $2,344.23 | $3,388.44 |
Martin's Point Setting Professional Modifier None Typical Low $1,778.28 Median $2,089.30 Typical High $3,162.28 | Professional | None | $1,778.28 | $2,089.30 | $3,162.28 |
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 $1,737.80 Median $2,454.71 Typical High $3,388.44 | Professional | None | $1,737.80 | $2,454.71 | $3,388.44 |
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 $891.25 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $891.25 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $354.81 Median $426.58 Typical High $426.58 | Professional | 53 · Discontinued | $354.81 | $426.58 | $426.58 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,318.26 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,318.26 | $1,584.89 | $1,584.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $263.03 Median $316.23 Typical High $316.23 | Professional | 55 · Aftercare only | $263.03 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $177.83 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $177.83 | $208.93 | $208.93 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,230.27 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,230.27 | $1,479.11 | $1,479.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,023.29 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $1,023.29 | $1,047.13 | $1,047.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $407.38 Median $426.58 Typical High $426.58 | Professional | 53 · Discontinued | $407.38 | $426.58 | $426.58 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,548.82 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,548.82 | $1,584.89 | $1,584.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $309.03 Median $316.23 Typical High $316.23 | Professional | 55 · Aftercare only | $309.03 | $316.23 | $316.23 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $204.17 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $204.17 | $208.93 | $208.93 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,445.44 | $1,479.11 | $1,479.11 |
Where Maine sits
The same service costs 7.6 times more in Maine than in Maryland. 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.
Physician feeFacility fee
ME $18,140MD $2,382
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.