How much rates vary
Facilitymedian $2,239 · 10th to 90th $708 to $3,715Professionalmedian $1,445 · 10th to 90th $1,072 to $2,089
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $1,096.48 Median $1,318.26 Typical High $1,318.26 | Professional | None | $1,096.48 | $1,318.26 | $1,318.26 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,071.52 Median $1,479.11 Typical High $2,290.87 | Professional | None | $1,071.52 | $1,479.11 | $2,290.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $660.69 Median $870.96 Typical High $1,318.26 | Professional | 62 · Two surgeons | $660.69 | $870.96 | $1,318.26 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $165.96 Median $223.87 Typical High $338.84 | Professional | 80 · Assistant surgeon | $165.96 | $223.87 | $338.84 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $147.91 Median $194.98 Typical High $295.12 | Professional | AS · PA/NP assist | $147.91 | $194.98 | $295.12 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,862.09 Typical High $2,570.40 | Facility | None | $707.95 | $1,862.09 | $2,570.40 |
Cigna Setting Professional Modifier None Typical Low $1,148.15 Median $1,621.81 Typical High $2,454.71 | Professional | None | $1,148.15 | $1,621.81 | $2,454.71 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,096.48 Median $1,513.56 Typical High $2,137.96 | Professional | None | $1,096.48 | $1,513.56 | $2,137.96 |
Martin's Point Setting Professional Modifier None Typical Low $1,122.02 Median $1,318.26 Typical High $1,318.26 | Professional | None | $1,122.02 | $1,318.26 | $1,318.26 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
United Setting Professional Modifier None Typical Low $1,071.52 Median $1,513.56 Typical High $2,187.76 | Professional | None | $1,071.52 | $1,513.56 | $2,187.76 |
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 $562.34 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $562.34 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $223.87 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $851.14 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $169.82 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $112.20 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $794.33 | $933.25 | $933.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $630.96 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $630.96 | $660.69 | $660.69 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $251.19 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $933.25 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $186.21 | $199.53 | $199.53 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $125.89 | $131.83 | $131.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $870.96 | $933.25 | $933.25 |
Where Maine sits
The same service costs 5.2 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
$1,445
AK $3,981TX $759
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.