How much rates vary
Facilitymedian $12,303 · 10th to 90th $776 to $12,882Professionalmedian $1,698 · 10th to 90th $1,288 to $2,512
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 $1,380.38 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,380.38 | $1,548.82 | $1,548.82 |
Anthem BCBS Setting Facility Modifier None Typical Low $9,772.37 Median $12,589.25 Typical High $13,182.57 | Facility | None | $9,772.37 | $12,589.25 | $13,182.57 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,258.93 Median $1,737.80 Typical High $2,691.53 | Professional | None | $1,258.93 | $1,737.80 | $2,691.53 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $794.33 Median $1,023.29 Typical High $1,548.82 | Professional | 62 · Two surgeons | $794.33 | $1,023.29 | $1,548.82 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $199.53 Median $263.03 Typical High $389.05 | Professional | 80 · Assistant surgeon | $199.53 | $263.03 | $389.05 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $173.78 Median $229.09 Typical High $346.74 | Professional | AS · PA/NP assist | $173.78 | $229.09 | $346.74 |
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 $1,380.38 Median $1,862.09 Typical High $2,884.03 | Professional | None | $1,380.38 | $1,862.09 | $2,884.03 |
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 $1,318.26 Median $1,698.24 Typical High $2,454.71 | Professional | None | $1,318.26 | $1,698.24 | $2,454.71 |
Martin's Point Setting Professional Modifier None Typical Low $1,479.11 Median $1,548.82 Typical High $1,548.82 | Professional | None | $1,479.11 | $1,548.82 | $1,548.82 |
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 $1,288.25 Median $1,819.70 Typical High $2,570.40 | Professional | None | $1,288.25 | $1,819.70 | $2,570.40 |
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 $691.83 Median $776.25 Typical High $776.25 | Professional | 52 · Reduced service | $691.83 | $776.25 | $776.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $275.42 Median $316.23 Typical High $316.23 | Professional | 53 · Discontinued | $275.42 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,174.90 Typical High $1,174.90 | Professional | 54 · Surgery only | $1,023.29 | $1,174.90 | $1,174.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $234.42 Typical High $234.42 | Professional | 55 · Aftercare only | $204.17 | $234.42 | $234.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $138.04 Median $154.88 Typical High $154.88 | Professional | 56 · Pre-op care only | $138.04 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $1,096.48 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $954.99 | $1,096.48 | $1,096.48 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $741.31 Median $776.25 Typical High $776.25 | Professional | 52 · Reduced service | $741.31 | $776.25 | $776.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $316.23 Typical High $316.23 | Professional | 53 · Discontinued | $295.12 | $316.23 | $316.23 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $1,174.90 Typical High $1,174.90 | Professional | 54 · Surgery only | $1,122.02 | $1,174.90 | $1,174.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $234.42 Typical High $234.42 | Professional | 55 · Aftercare only | $223.87 | $234.42 | $234.42 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $154.88 Typical High $154.88 | Professional | 56 · Pre-op care only | $147.91 | $154.88 | $154.88 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,096.48 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,096.48 | $1,096.48 |
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· 22nd of 51
$1,778
AK $4,571TX $851
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.