How much rates vary
Facilitymedian $12,303 · 10th to 90th $776 to $12,882Professionalmedian $1,950 · 10th to 90th $1,479 to $2,951
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 $1,548.82 Median $1,819.70 Typical High $1,819.70 | Professional | None | $1,548.82 | $1,819.70 | $1,819.70 |
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 $1,479.11 Median $2,041.74 Typical High $3,090.30 | Professional | None | $1,479.11 | $2,041.74 | $3,090.30 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $933.25 Median $1,230.27 Typical High $1,862.09 | Professional | 62 · Two surgeons | $933.25 | $1,230.27 | $1,862.09 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $239.88 Median $309.03 Typical High $467.74 | Professional | 80 · Assistant surgeon | $239.88 | $309.03 | $467.74 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $208.93 Median $269.15 Typical High $407.38 | Professional | AS · PA/NP assist | $208.93 | $269.15 | $407.38 |
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 $1,584.89 Median $2,238.72 Typical High $3,388.44 | Professional | None | $1,584.89 | $2,238.72 | $3,388.44 |
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 $1,548.82 Median $1,949.84 Typical High $3,019.95 | Professional | None | $1,548.82 | $1,949.84 | $3,019.95 |
Martin's Point Setting Professional Modifier None Typical Low $1,584.89 Median $1,819.70 Typical High $1,819.70 | Professional | None | $1,584.89 | $1,819.70 | $1,819.70 |
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 $1,445.44 Median $1,949.84 Typical High $3,019.95 | Professional | None | $1,445.44 | $1,949.84 | $3,019.95 |
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 $776.25 Median $912.01 Typical High $912.01 | Professional | 52 · Reduced service | $776.25 | $912.01 | $912.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $371.54 Typical High $371.54 | Professional | 53 · Discontinued | $309.03 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $1,380.38 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,148.15 | $1,380.38 | $1,380.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $275.42 Typical High $275.42 | Professional | 55 · Aftercare only | $229.09 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $181.97 Typical High $181.97 | Professional | 56 · Pre-op care only | $154.88 | $181.97 | $181.97 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,288.25 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,288.25 | $1,288.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $794.33 Median $912.01 Typical High $912.01 | Professional | 52 · Reduced service | $794.33 | $912.01 | $912.01 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $371.54 Typical High $371.54 | Professional | 53 · Discontinued | $316.23 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,380.38 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,202.26 | $1,380.38 | $1,380.38 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $275.42 Typical High $275.42 | Professional | 55 · Aftercare only | $239.88 | $275.42 | $275.42 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $181.97 Typical High $181.97 | Professional | 56 · Pre-op care only | $158.49 | $181.97 | $181.97 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,288.25 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,288.25 | $1,288.25 |
Where Maine sits
The same service costs 5.1 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
$1,995
AK $5,129TX $1,000
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.