How much rates vary
Facilitymedian $12,303 · 10th to 90th $776 to $12,882Professionalmedian $5,495 · 10th to 90th $4,074 to $7,943
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 $4,168.69 Median $5,011.87 Typical High $5,011.87 | Professional | None | $4,168.69 | $5,011.87 | $5,011.87 |
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 $4,073.80 Median $5,623.41 Typical High $8,511.38 | Professional | None | $4,073.80 | $5,623.41 | $8,511.38 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,570.40 Median $3,311.31 Typical High $5,011.87 | Professional | 62 · Two surgeons | $2,570.40 | $3,311.31 | $5,011.87 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $660.69 Median $851.14 Typical High $1,288.25 | Professional | 80 · Assistant surgeon | $660.69 | $851.14 | $1,288.25 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $575.44 Median $741.31 Typical High $1,122.02 | Professional | AS · PA/NP assist | $575.44 | $741.31 | $1,122.02 |
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 $4,365.16 Median $6,025.60 Typical High $9,120.11 | Professional | None | $4,365.16 | $6,025.60 | $9,120.11 |
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 $4,168.69 Median $5,623.41 Typical High $8,128.31 | Professional | None | $4,168.69 | $5,623.41 | $8,128.31 |
Martin's Point Setting Professional Modifier None Typical Low $4,570.88 Median $5,011.87 Typical High $5,011.87 | Professional | None | $4,570.88 | $5,011.87 | $5,011.87 |
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 $3,981.07 Median $5,623.41 Typical High $8,128.31 | Professional | None | $3,981.07 | $5,623.41 | $8,128.31 |
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 $2,089.30 Median $2,511.89 Typical High $2,511.89 | Professional | 52 · Reduced service | $2,089.30 | $2,511.89 | $2,511.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $851.14 Median $1,000.00 Typical High $1,000.00 | Professional | 53 · Discontinued | $851.14 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3,162.28 Median $3,801.89 Typical High $3,801.89 | Professional | 54 · Surgery only | $3,162.28 | $3,801.89 | $3,801.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $630.96 Median $758.58 Typical High $758.58 | Professional | 55 · Aftercare only | $630.96 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $416.87 Median $501.19 Typical High $501.19 | Professional | 56 · Pre-op care only | $416.87 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,951.21 Median $3,548.13 Typical High $3,548.13 | Professional | 78 · Unplanned return to OR | $2,951.21 | $3,548.13 | $3,548.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2,290.87 Median $2,511.89 Typical High $2,511.89 | Professional | 52 · Reduced service | $2,290.87 | $2,511.89 | $2,511.89 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $912.01 Median $1,000.00 Typical High $1,000.00 | Professional | 53 · Discontinued | $912.01 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $3,388.44 Median $3,801.89 Typical High $3,801.89 | Professional | 54 · Surgery only | $3,388.44 | $3,801.89 | $3,801.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $676.08 Median $758.58 Typical High $758.58 | Professional | 55 · Aftercare only | $676.08 | $758.58 | $758.58 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $457.09 Median $501.19 Typical High $501.19 | Professional | 56 · Pre-op care only | $457.09 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,162.28 Median $3,548.13 Typical High $3,548.13 | Professional | 78 · Unplanned return to OR | $3,162.28 | $3,548.13 | $3,548.13 |
Where Maine sits
The same service costs 21.9 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· 19th of 51
$5,623
AK $14,125TX $646
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.