How much rates vary
Facilitymedian $813 · 10th to 90th $776 to $1,202Professionalmedian $4,266 · 10th to 90th $3,467 to $6,761
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 $3,548.13 Median $4,265.80 Typical High $4,265.80 | Professional | None | $3,548.13 | $4,265.80 | $4,265.80 |
Anthem BCBS Setting Professional Modifier None Typical Low $3,467.37 Median $4,786.30 Typical High $7,244.36 | Professional | None | $3,467.37 | $4,786.30 | $7,244.36 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,187.76 Median $2,818.38 Typical High $4,265.80 | Professional | 62 · Two surgeons | $2,187.76 | $2,818.38 | $4,265.80 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $549.54 Median $724.44 Typical High $1,096.48 | Professional | 80 · Assistant surgeon | $549.54 | $724.44 | $1,096.48 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $489.78 Median $630.96 Typical High $954.99 | Professional | AS · PA/NP assist | $489.78 | $630.96 | $954.99 |
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 $3,548.13 Median $4,786.30 Typical High $6,918.31 | Professional | None | $3,548.13 | $4,786.30 | $6,918.31 |
Martin's Point Setting Professional Modifier None Typical Low $3,715.35 Median $4,265.80 Typical High $4,265.80 | Professional | None | $3,715.35 | $4,265.80 | $4,265.80 |
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 $3,467.37 Median $5,011.87 Typical High $6,918.31 | Professional | None | $3,467.37 | $5,011.87 | $6,918.31 |
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 $1,778.28 Median $2,137.96 Typical High $2,137.96 | Professional | 52 · Reduced service | $1,778.28 | $2,137.96 | $2,137.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $707.95 Median $851.14 Typical High $851.14 | Professional | 53 · Discontinued | $707.95 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,691.53 Median $3,162.28 Typical High $3,162.28 | Professional | 54 · Surgery only | $2,691.53 | $3,162.28 | $3,162.28 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $537.03 Median $645.65 Typical High $645.65 | Professional | 55 · Aftercare only | $537.03 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $354.81 Median $426.58 Typical High $426.58 | Professional | 56 · Pre-op care only | $354.81 | $426.58 | $426.58 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,511.89 Median $2,951.21 Typical High $2,951.21 | Professional | 78 · Unplanned return to OR | $2,511.89 | $2,951.21 | $2,951.21 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,862.09 Median $2,137.96 Typical High $2,137.96 | Professional | 52 · Reduced service | $1,862.09 | $2,137.96 | $2,137.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $741.31 Median $851.14 Typical High $851.14 | Professional | 53 · Discontinued | $741.31 | $851.14 | $851.14 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $2,818.38 Median $3,162.28 Typical High $3,162.28 | Professional | 54 · Surgery only | $2,818.38 | $3,162.28 | $3,162.28 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $562.34 Median $645.65 Typical High $645.65 | Professional | 55 · Aftercare only | $562.34 | $645.65 | $645.65 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $371.54 Median $426.58 Typical High $426.58 | Professional | 56 · Pre-op care only | $371.54 | $426.58 | $426.58 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,630.27 Median $2,951.21 Typical High $2,951.21 | Professional | 78 · Unplanned return to OR | $2,630.27 | $2,951.21 | $2,951.21 |
Where Maine sits
The same service costs 27.5 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· 29th of 51
$4,266
AK $14,454TX $525
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.