How much rates vary
Facilitymedian $776 · 10th to 90th $708 to $1,202Professionalmedian $5,495 · 10th to 90th $4,169 to $8,128
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 $4,265.80 Median $5,128.61 Typical High $5,128.61 | Professional | None | $4,265.80 | $5,128.61 | $5,128.61 |
Anthem BCBS Setting Professional Modifier None Typical Low $4,168.69 Median $5,754.40 Typical High $8,709.64 | Professional | None | $4,168.69 | $5,754.40 | $8,709.64 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,630.27 Median $3,388.44 Typical High $5,128.61 | Professional | 62 · Two surgeons | $2,630.27 | $3,388.44 | $5,128.61 |
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 $758.58 Typical High $1,148.15 | Professional | AS · PA/NP assist | $575.44 | $758.58 | $1,148.15 |
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 $4,570.88 Median $6,165.95 Typical High $9,332.54 | Professional | None | $4,570.88 | $6,165.95 | $9,332.54 |
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 $4,265.80 Median $5,754.40 Typical High $8,128.31 | Professional | None | $4,265.80 | $5,754.40 | $8,128.31 |
Martin's Point Setting Professional Modifier None Typical Low $4,466.84 Median $5,128.61 Typical High $5,128.61 | Professional | None | $4,466.84 | $5,128.61 | $5,128.61 |
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 $4,168.69 Median $5,888.44 Typical High $8,317.64 | Professional | None | $4,168.69 | $5,888.44 | $8,317.64 |
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 $2,137.96 Median $2,570.40 Typical High $2,570.40 | Professional | 52 · Reduced service | $2,137.96 | $2,570.40 | $2,570.40 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $851.14 Median $1,023.29 Typical High $1,023.29 | Professional | 53 · Discontinued | $851.14 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3,235.94 Median $3,801.89 Typical High $3,801.89 | Professional | 54 · Surgery only | $3,235.94 | $3,801.89 | $3,801.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $645.65 Median $758.58 Typical High $758.58 | Professional | 55 · Aftercare only | $645.65 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $426.58 Median $512.86 Typical High $512.86 | Professional | 56 · Pre-op care only | $426.58 | $512.86 | $512.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,019.95 Median $3,548.13 Typical High $3,548.13 | Professional | 78 · Unplanned return to OR | $3,019.95 | $3,548.13 | $3,548.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2,238.72 Median $2,570.40 Typical High $2,570.40 | Professional | 52 · Reduced service | $2,238.72 | $2,570.40 | $2,570.40 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $912.01 Median $1,023.29 Typical High $1,023.29 | Professional | 53 · Discontinued | $912.01 | $1,023.29 | $1,023.29 |
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 $446.68 Median $512.86 Typical High $512.86 | Professional | 56 · Pre-op care only | $446.68 | $512.86 | $512.86 |
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 20.9 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· 21st of 51
$5,495
AK $14,125TX $676
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.