How much rates vary
Facilitymedian $12,303 · 10th to 90th $776 to $12,882Professionalmedian $3,236 · 10th to 90th $2,455 to $4,898
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 $2,511.89 Median $2,951.21 Typical High $2,951.21 | Professional | None | $2,511.89 | $2,951.21 | $2,951.21 |
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 $2,454.71 Median $3,311.31 Typical High $5,370.32 | Professional | None | $2,454.71 | $3,311.31 | $5,370.32 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,548.82 Median $1,995.26 Typical High $3,019.95 | Professional | 62 · Two surgeons | $1,548.82 | $1,995.26 | $3,019.95 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $389.05 Median $501.19 Typical High $758.58 | Professional | 80 · Assistant surgeon | $389.05 | $501.19 | $758.58 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $338.84 Median $446.68 Typical High $676.08 | Professional | AS · PA/NP assist | $338.84 | $446.68 | $676.08 |
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 $2,630.27 Median $3,630.78 Typical High $5,495.41 | Professional | None | $2,630.27 | $3,630.78 | $5,495.41 |
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 $2,511.89 Median $3,388.44 Typical High $4,897.79 | Professional | None | $2,511.89 | $3,388.44 | $4,897.79 |
Martin's Point Setting Professional Modifier None Typical Low $2,884.03 Median $2,951.21 Typical High $2,951.21 | Professional | None | $2,884.03 | $2,951.21 | $2,951.21 |
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 $2,398.83 Median $3,388.44 Typical High $4,897.79 | Professional | None | $2,398.83 | $3,388.44 | $4,897.79 |
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 $1,258.93 Median $1,479.11 Typical High $1,479.11 | Professional | 52 · Reduced service | $1,258.93 | $1,479.11 | $1,479.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $501.19 Median $602.56 Typical High $602.56 | Professional | 53 · Discontinued | $501.19 | $602.56 | $602.56 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,905.46 Median $2,238.72 Typical High $2,238.72 | Professional | 54 · Surgery only | $1,905.46 | $2,238.72 | $2,238.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $380.19 Median $446.68 Typical High $446.68 | Professional | 55 · Aftercare only | $380.19 | $446.68 | $446.68 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $251.19 Median $295.12 Typical High $295.12 | Professional | 56 · Pre-op care only | $251.19 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,778.28 Median $2,089.30 Typical High $2,089.30 | Professional | 78 · Unplanned return to OR | $1,778.28 | $2,089.30 | $2,089.30 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,412.54 Median $1,479.11 Typical High $1,479.11 | Professional | 52 · Reduced service | $1,412.54 | $1,479.11 | $1,479.11 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $575.44 Median $602.56 Typical High $602.56 | Professional | 53 · Discontinued | $575.44 | $602.56 | $602.56 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,137.96 Median $2,238.72 Typical High $2,238.72 | Professional | 54 · Surgery only | $2,137.96 | $2,238.72 | $2,238.72 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $426.58 Median $446.68 Typical High $446.68 | Professional | 55 · Aftercare only | $426.58 | $446.68 | $446.68 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $288.40 Median $295.12 Typical High $295.12 | Professional | 56 · Pre-op care only | $288.40 | $295.12 | $295.12 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,995.26 Median $2,089.30 Typical High $2,089.30 | Professional | 78 · Unplanned return to OR | $1,995.26 | $2,089.30 | $2,089.30 |
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· 20th of 51
$3,388
AK $8,710TX $1,622
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.