How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $2,042 · 10th to 90th $1,514 to $2,951
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 $1,548.82 Median $1,862.09 Typical High $1,862.09 | Professional | None | $1,548.82 | $1,862.09 | $1,862.09 |
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 $1,513.56 Median $2,089.30 Typical High $3,162.28 | Professional | None | $1,513.56 | $2,089.30 | $3,162.28 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $954.99 Median $1,230.27 Typical High $1,862.09 | Professional | 62 · Two surgeons | $954.99 | $1,230.27 | $1,862.09 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $239.88 Median $309.03 Typical High $478.63 | Professional | 80 · Assistant surgeon | $239.88 | $309.03 | $478.63 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $208.93 Median $275.42 Typical High $416.87 | Professional | AS · PA/NP assist | $208.93 | $275.42 | $416.87 |
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 $2,238.72 Typical High $3,388.44 | Professional | None | $1,659.59 | $2,238.72 | $3,388.44 |
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 $1,548.82 Median $2,089.30 Typical High $2,951.21 | Professional | None | $1,548.82 | $2,089.30 | $2,951.21 |
Martin's Point Setting Professional Modifier None Typical Low $1,819.70 Median $1,862.09 Typical High $1,862.09 | Professional | None | $1,819.70 | $1,862.09 | $1,862.09 |
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 $1,513.56 Median $2,137.96 Typical High $3,019.95 | Professional | None | $1,513.56 | $2,137.96 | $3,019.95 |
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 $776.25 Median $933.25 Typical High $933.25 | Professional | 52 · Reduced service | $776.25 | $933.25 | $933.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $371.54 Typical High $371.54 | Professional | 53 · Discontinued | $316.23 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,412.54 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,174.90 | $1,412.54 | $1,412.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $281.84 Typical High $281.84 | Professional | 55 · Aftercare only | $234.42 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $186.21 Typical High $186.21 | Professional | 56 · Pre-op care only | $154.88 | $186.21 | $186.21 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,318.26 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $912.01 Median $933.25 Typical High $933.25 | Professional | 52 · Reduced service | $912.01 | $933.25 | $933.25 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $363.08 Median $371.54 Typical High $371.54 | Professional | 53 · Discontinued | $363.08 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,348.96 Median $1,412.54 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,348.96 | $1,412.54 | $1,412.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $281.84 Typical High $281.84 | Professional | 55 · Aftercare only | $269.15 | $281.84 | $281.84 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $181.97 Median $186.21 Typical High $186.21 | Professional | 56 · Pre-op care only | $181.97 | $186.21 | $186.21 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $1,318.26 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,258.93 | $1,318.26 | $1,318.26 |
Where Maine sits
The same service costs 8.2 times more in Maine than in Maryland. 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 $17,891MD $2,184
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.