How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $1,380 · 10th to 90th $1,023 to $2,042
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 $1,071.52 Median $1,258.93 Typical High $1,258.93 | Professional | None | $1,071.52 | $1,258.93 | $1,258.93 |
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 $1,023.29 Median $1,412.54 Typical High $2,137.96 | Professional | None | $1,023.29 | $1,412.54 | $2,137.96 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $645.65 Median $851.14 Typical High $1,288.25 | Professional | 62 · Two surgeons | $645.65 | $851.14 | $1,288.25 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $165.96 Median $213.80 Typical High $323.59 | Professional | 80 · Assistant surgeon | $165.96 | $213.80 | $323.59 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $144.54 Median $186.21 Typical High $281.84 | Professional | AS · PA/NP assist | $144.54 | $186.21 | $281.84 |
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 $1,148.15 Median $1,548.82 Typical High $2,344.23 | Professional | None | $1,148.15 | $1,548.82 | $2,344.23 |
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 $1,071.52 Median $1,445.44 Typical High $2,041.74 | Professional | None | $1,071.52 | $1,445.44 | $2,041.74 |
Martin's Point Setting Professional Modifier None Typical Low $1,230.27 Median $1,258.93 Typical High $1,258.93 | Professional | None | $1,230.27 | $1,258.93 | $1,258.93 |
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 $1,023.29 Median $1,445.44 Typical High $2,089.30 | Professional | None | $1,023.29 | $1,445.44 | $2,089.30 |
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 $537.03 Median $630.96 Typical High $630.96 | Professional | 52 · Reduced service | $537.03 | $630.96 | $630.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $213.80 Median $251.19 Typical High $251.19 | Professional | 53 · Discontinued | $213.80 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $794.33 Median $954.99 Typical High $954.99 | Professional | 54 · Surgery only | $794.33 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $158.49 Median $190.55 Typical High $190.55 | Professional | 55 · Aftercare only | $158.49 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $107.15 Median $125.89 Typical High $125.89 | Professional | 56 · Pre-op care only | $107.15 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $891.25 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $741.31 | $891.25 | $891.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $616.60 Median $630.96 Typical High $630.96 | Professional | 52 · Reduced service | $616.60 | $630.96 | $630.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $251.19 Typical High $251.19 | Professional | 53 · Discontinued | $245.47 | $251.19 | $251.19 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $954.99 Typical High $954.99 | Professional | 54 · Surgery only | $933.25 | $954.99 | $954.99 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $190.55 Typical High $190.55 | Professional | 55 · Aftercare only | $186.21 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $125.89 Typical High $125.89 | Professional | 56 · Pre-op care only | $123.03 | $125.89 | $125.89 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $891.25 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $870.96 | $891.25 | $891.25 |
Where Maine sits
The same service costs 24.5 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· 22nd of 51
$1,445
AK $4,266TX $174
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.