How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $2,818 · 10th to 90th $2,089 to $4,074
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 $2,137.96 Median $2,570.40 Typical High $2,570.40 | Professional | None | $2,137.96 | $2,570.40 | $2,570.40 |
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 $2,089.30 Median $2,884.03 Typical High $4,365.16 | Professional | None | $2,089.30 | $2,884.03 | $4,365.16 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,318.26 Median $1,698.24 Typical High $2,570.40 | Professional | 62 · Two surgeons | $1,318.26 | $1,698.24 | $2,570.40 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $331.13 Median $426.58 Typical High $660.69 | Professional | 80 · Assistant surgeon | $331.13 | $426.58 | $660.69 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $288.40 Median $380.19 Typical High $575.44 | Professional | AS · PA/NP assist | $288.40 | $380.19 | $575.44 |
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 $2,290.87 Median $3,090.30 Typical High $4,677.35 | Professional | None | $2,290.87 | $3,090.30 | $4,677.35 |
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 $2,137.96 Median $2,884.03 Typical High $4,073.80 | Professional | None | $2,137.96 | $2,884.03 | $4,073.80 |
Martin's Point Setting Professional Modifier None Typical Low $2,344.23 Median $2,570.40 Typical High $2,570.40 | Professional | None | $2,344.23 | $2,570.40 | $2,570.40 |
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 $2,089.30 Median $3,019.95 Typical High $4,168.69 | Professional | None | $2,089.30 | $3,019.95 | $4,168.69 |
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 $1,071.52 Median $1,288.25 Typical High $1,288.25 | Professional | 52 · Reduced service | $1,071.52 | $1,288.25 | $1,288.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $436.52 Median $512.86 Typical High $512.86 | Professional | 53 · Discontinued | $436.52 | $512.86 | $512.86 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,621.81 Median $1,949.84 Typical High $1,949.84 | Professional | 54 · Surgery only | $1,621.81 | $1,949.84 | $1,949.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $323.59 Median $389.05 Typical High $389.05 | Professional | 55 · Aftercare only | $323.59 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $213.80 Median $257.04 Typical High $257.04 | Professional | 56 · Pre-op care only | $213.80 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,513.56 Median $1,819.70 Typical High $1,819.70 | Professional | 78 · Unplanned return to OR | $1,513.56 | $1,819.70 | $1,819.70 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,174.90 Median $1,288.25 Typical High $1,288.25 | Professional | 52 · Reduced service | $1,174.90 | $1,288.25 | $1,288.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $467.74 Median $512.86 Typical High $512.86 | Professional | 53 · Discontinued | $467.74 | $512.86 | $512.86 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,778.28 Median $1,949.84 Typical High $1,949.84 | Professional | 54 · Surgery only | $1,778.28 | $1,949.84 | $1,949.84 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $354.81 Median $389.05 Typical High $389.05 | Professional | 55 · Aftercare only | $354.81 | $389.05 | $389.05 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $234.42 Median $257.04 Typical High $257.04 | Professional | 56 · Pre-op care only | $234.42 | $257.04 | $257.04 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,659.59 Median $1,819.70 Typical High $1,819.70 | Professional | 78 · Unplanned return to OR | $1,659.59 | $1,819.70 | $1,819.70 |
Where Maine sits
The same service costs 7.6 times more in Maine 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.
Physician feeFacility fee
ME $18,667TX $2,469
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.