How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $1,820 · 10th to 90th $1,380 to $2,754
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 $1,412.54 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,412.54 | $1,698.24 | $1,698.24 |
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 $1,380.38 Median $1,905.46 Typical High $2,884.03 | Professional | None | $1,380.38 | $1,905.46 | $2,884.03 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $870.96 Median $1,122.02 Typical High $1,698.24 | Professional | 62 · Two surgeons | $870.96 | $1,122.02 | $1,698.24 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $218.78 Median $281.84 Typical High $436.52 | Professional | 80 · Assistant surgeon | $218.78 | $281.84 | $436.52 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $190.55 Median $251.19 Typical High $380.19 | Professional | AS · PA/NP assist | $190.55 | $251.19 | $380.19 |
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 $2,041.74 Typical High $3,090.30 | Professional | None | $1,479.11 | $2,041.74 | $3,090.30 |
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 $1,412.54 Median $1,905.46 Typical High $2,754.23 | Professional | None | $1,412.54 | $1,905.46 | $2,754.23 |
Martin's Point Setting Professional Modifier None Typical Low $1,659.59 Median $1,698.24 Typical High $1,698.24 | Professional | None | $1,659.59 | $1,698.24 | $1,698.24 |
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 $1,380.38 Median $1,949.84 Typical High $2,754.23 | Professional | None | $1,380.38 | $1,949.84 | $2,754.23 |
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 $707.95 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $707.95 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $281.84 Median $338.84 Typical High $338.84 | Professional | 53 · Discontinued | $281.84 | $338.84 | $338.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,258.93 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,071.52 | $1,258.93 | $1,258.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $251.19 Typical High $251.19 | Professional | 55 · Aftercare only | $213.80 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $169.82 Typical High $169.82 | Professional | 56 · Pre-op care only | $141.25 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,174.90 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,174.90 | $1,174.90 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $831.76 Median $851.14 Typical High $851.14 | Professional | 52 · Reduced service | $831.76 | $851.14 | $851.14 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $331.13 Median $338.84 Typical High $338.84 | Professional | 53 · Discontinued | $331.13 | $338.84 | $338.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,230.27 Median $1,258.93 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,230.27 | $1,258.93 | $1,258.93 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $245.47 Median $251.19 Typical High $251.19 | Professional | 55 · Aftercare only | $245.47 | $251.19 | $251.19 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $165.96 Median $169.82 Typical High $169.82 | Professional | 56 · Pre-op care only | $165.96 | $169.82 | $169.82 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,148.15 Median $1,174.90 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,148.15 | $1,174.90 | $1,174.90 |
Where Maine sits
The same service costs 5.2 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
$1,905
AK $4,898TX $933
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.