How much rates vary
Facilitymedian $12,303 · 10th to 90th $776 to $12,882Professionalmedian $2,138 · 10th to 90th $1,622 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 $1,659.59 Median $1,995.26 Typical High $1,995.26 | Professional | None | $1,659.59 | $1,995.26 | $1,995.26 |
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 $1,621.81 Median $2,187.76 Typical High $3,388.44 | Professional | None | $1,621.81 | $2,187.76 | $3,388.44 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,023.29 Median $1,318.26 Typical High $1,995.26 | Professional | 62 · Two surgeons | $1,023.29 | $1,318.26 | $1,995.26 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $257.04 Median $331.13 Typical High $501.19 | Professional | 80 · Assistant surgeon | $257.04 | $331.13 | $501.19 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $223.87 Median $295.12 Typical High $446.68 | Professional | AS · PA/NP assist | $223.87 | $295.12 | $446.68 |
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 $1,737.80 Median $2,398.83 Typical High $3,630.78 | Professional | None | $1,737.80 | $2,398.83 | $3,630.78 |
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 $1,659.59 Median $2,238.72 Typical High $3,235.94 | Professional | None | $1,659.59 | $2,238.72 | $3,235.94 |
Martin's Point Setting Professional Modifier None Typical Low $1,949.84 Median $1,995.26 Typical High $1,995.26 | Professional | None | $1,949.84 | $1,995.26 | $1,995.26 |
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 $1,621.81 Median $2,290.87 Typical High $3,235.94 | Professional | None | $1,621.81 | $2,290.87 | $3,235.94 |
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 $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | 52 · Reduced service | $831.76 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $331.13 Median $398.11 Typical High $398.11 | Professional | 53 · Discontinued | $331.13 | $398.11 | $398.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $1,479.11 Typical High $1,479.11 | Professional | 54 · Surgery only | $1,258.93 | $1,479.11 | $1,479.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $295.12 Typical High $295.12 | Professional | 55 · Aftercare only | $251.19 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $165.96 Median $199.53 Typical High $199.53 | Professional | 56 · Pre-op care only | $165.96 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $1,380.38 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $1,174.90 | $1,380.38 | $1,380.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $977.24 Median $1,000.00 Typical High $1,000.00 | Professional | 52 · Reduced service | $977.24 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $398.11 Typical High $398.11 | Professional | 53 · Discontinued | $389.05 | $398.11 | $398.11 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,479.11 Typical High $1,479.11 | Professional | 54 · Surgery only | $1,445.44 | $1,479.11 | $1,479.11 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $295.12 Typical High $295.12 | Professional | 55 · Aftercare only | $288.40 | $295.12 | $295.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $199.53 Typical High $199.53 | Professional | 56 · Pre-op care only | $194.98 | $199.53 | $199.53 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,380.38 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,380.38 | $1,380.38 |
Where Maine sits
The same service costs 20.4 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· 20th of 51
$2,239
AK $5,495TX $269
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.