How much rates vary
Facilitymedian $7,413 · 10th to 90th $776 to $7,586Professionalmedian $1,549 · 10th to 90th $1,175 to $2,344
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 $1,202.26 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,202.26 | $1,445.44 | $1,445.44 |
Anthem BCBS Setting Facility Modifier None Typical Low $5,754.40 Median $7,413.10 Typical High $7,762.47 | Facility | None | $5,754.40 | $7,413.10 | $7,762.47 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,174.90 Median $1,621.81 Typical High $2,454.71 | Professional | None | $1,174.90 | $1,621.81 | $2,454.71 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $741.31 Median $954.99 Typical High $1,445.44 | Professional | 62 · Two surgeons | $741.31 | $954.99 | $1,445.44 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $190.55 Median $245.47 Typical High $371.54 | Professional | 80 · Assistant surgeon | $190.55 | $245.47 | $371.54 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $165.96 Median $213.80 Typical High $323.59 | Professional | AS · PA/NP assist | $165.96 | $213.80 | $323.59 |
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 $1,230.27 Median $1,737.80 Typical High $2,630.27 | Professional | None | $1,230.27 | $1,737.80 | $2,630.27 |
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 $1,202.26 Median $1,621.81 Typical High $2,344.23 | Professional | None | $1,202.26 | $1,621.81 | $2,344.23 |
Martin's Point Setting Professional Modifier None Typical Low $1,230.27 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,230.27 | $1,445.44 | $1,445.44 |
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 $1,174.90 Median $1,659.59 Typical High $2,344.23 | Professional | None | $1,174.90 | $1,659.59 | $2,344.23 |
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 $616.60 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $616.60 | $724.44 | $724.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $288.40 Typical High $288.40 | Professional | 53 · Discontinued | $245.47 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $1,096.48 Typical High $1,096.48 | Professional | 54 · Surgery only | $912.01 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $181.97 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $144.54 Typical High $144.54 | Professional | 56 · Pre-op care only | $123.03 | $144.54 | $144.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $1,023.29 Typical High $1,023.29 | Professional | 78 · Unplanned return to OR | $851.14 | $1,023.29 | $1,023.29 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $645.65 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $645.65 | $724.44 | $724.44 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $288.40 Typical High $288.40 | Professional | 53 · Discontinued | $263.03 | $288.40 | $288.40 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $977.24 Median $1,096.48 Typical High $1,096.48 | Professional | 54 · Surgery only | $977.24 | $1,096.48 | $1,096.48 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $194.98 Median $218.78 Typical High $218.78 | Professional | 55 · Aftercare only | $194.98 | $218.78 | $218.78 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $144.54 Typical High $144.54 | Professional | 56 · Pre-op care only | $131.83 | $144.54 | $144.54 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $1,023.29 Typical High $1,023.29 | Professional | 78 · Unplanned return to OR | $912.01 | $1,023.29 | $1,023.29 |
Where Maine sits
The same service costs 5.9 times more in Alabama than in Maryland. 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.
Physician feeFacility fee
AL $10,682MD $1,821
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.