How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $1,905 · 10th to 90th $1,445 to $2,818
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 $1,479.11 Median $1,778.28 Typical High $1,778.28 | Professional | None | $1,479.11 | $1,778.28 | $1,778.28 |
Anthem BCBS Setting Facility Modifier None Typical Low $12,589.25 Median $16,218.10 Typical High $16,982.44 | Facility | None | $12,589.25 | $16,218.10 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,445.44 Median $1,995.26 Typical High $3,019.95 | Professional | None | $1,445.44 | $1,995.26 | $3,019.95 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $912.01 Median $1,174.90 Typical High $1,778.28 | Professional | 62 · Two surgeons | $912.01 | $1,174.90 | $1,778.28 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $229.09 Median $295.12 Typical High $457.09 | Professional | 80 · Assistant surgeon | $229.09 | $295.12 | $457.09 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $199.53 Median $263.03 Typical High $398.11 | Professional | AS · PA/NP assist | $199.53 | $263.03 | $398.11 |
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 $1,659.59 Median $2,137.96 Typical High $3,235.94 | Professional | None | $1,659.59 | $2,137.96 | $3,235.94 |
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 $1,445.44 Median $1,905.46 Typical High $2,818.38 | Professional | None | $1,445.44 | $1,905.46 | $2,818.38 |
Martin's Point Setting Professional Modifier None Typical Low $1,513.56 Median $1,778.28 Typical High $1,778.28 | Professional | None | $1,513.56 | $1,778.28 | $1,778.28 |
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 $1,412.54 Median $1,905.46 Typical High $2,884.03 | Professional | None | $1,412.54 | $1,905.46 | $2,884.03 |
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 $741.31 Median $891.25 Typical High $891.25 | Professional | 52 · Reduced service | $741.31 | $891.25 | $891.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $354.81 Typical High $354.81 | Professional | 53 · Discontinued | $295.12 | $354.81 | $354.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $1,318.26 Typical High $1,318.26 | Professional | 54 · Surgery only | $1,122.02 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $263.03 Typical High $263.03 | Professional | 55 · Aftercare only | $223.87 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $177.83 Typical High $177.83 | Professional | 56 · Pre-op care only | $147.91 | $177.83 | $177.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,230.27 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,230.27 | $1,230.27 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $758.58 Median $891.25 Typical High $891.25 | Professional | 52 · Reduced service | $758.58 | $891.25 | $891.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $354.81 Typical High $354.81 | Professional | 53 · Discontinued | $302.00 | $354.81 | $354.81 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $1,318.26 Typical High $1,318.26 | Professional | 54 · Surgery only | $1,122.02 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $263.03 Typical High $263.03 | Professional | 55 · Aftercare only | $223.87 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $177.83 Typical High $177.83 | Professional | 56 · Pre-op care only | $151.36 | $177.83 | $177.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,230.27 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,230.27 | $1,230.27 |
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· 23rd of 51
$1,905
AK $5,129TX $977
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.