How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $1,738 · 10th to 90th $1,288 to $2,570
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 $1,318.26 Median $1,584.89 Typical High $1,584.89 | Professional | None | $1,318.26 | $1,584.89 | $1,584.89 |
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 $1,288.25 Median $1,778.28 Typical High $2,691.53 | Professional | None | $1,288.25 | $1,778.28 | $2,691.53 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $812.83 Median $1,047.13 Typical High $1,584.89 | Professional | 62 · Two surgeons | $812.83 | $1,047.13 | $1,584.89 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $208.93 Median $269.15 Typical High $407.38 | Professional | 80 · Assistant surgeon | $208.93 | $269.15 | $407.38 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $181.97 Median $234.42 Typical High $354.81 | Professional | AS · PA/NP assist | $181.97 | $234.42 | $354.81 |
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 $1,380.38 Median $1,905.46 Typical High $2,884.03 | Professional | None | $1,380.38 | $1,905.46 | $2,884.03 |
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 $1,318.26 Median $1,778.28 Typical High $2,570.40 | Professional | None | $1,318.26 | $1,778.28 | $2,570.40 |
Martin's Point Setting Professional Modifier None Typical Low $1,380.38 Median $1,584.89 Typical High $1,584.89 | Professional | None | $1,380.38 | $1,584.89 | $1,584.89 |
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 $1,288.25 Median $1,862.09 Typical High $2,570.40 | Professional | None | $1,288.25 | $1,862.09 | $2,570.40 |
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 $660.69 Median $794.33 Typical High $794.33 | Professional | 52 · Reduced service | $660.69 | $794.33 | $794.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $316.23 Typical High $316.23 | Professional | 53 · Discontinued | $269.15 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,202.26 Typical High $1,202.26 | Professional | 54 · Surgery only | $1,000.00 | $1,202.26 | $1,202.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $239.88 Typical High $239.88 | Professional | 55 · Aftercare only | $199.53 | $239.88 | $239.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $158.49 Typical High $158.49 | Professional | 56 · Pre-op care only | $134.90 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $1,122.02 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $933.25 | $1,122.02 | $1,122.02 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $776.25 Median $794.33 Typical High $794.33 | Professional | 52 · Reduced service | $776.25 | $794.33 | $794.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $316.23 Typical High $316.23 | Professional | 53 · Discontinued | $309.03 | $316.23 | $316.23 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,202.26 Typical High $1,202.26 | Professional | 54 · Surgery only | $1,174.90 | $1,202.26 | $1,202.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $239.88 Typical High $239.88 | Professional | 55 · Aftercare only | $234.42 | $239.88 | $239.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $158.49 Typical High $158.49 | Professional | 56 · Pre-op care only | $154.88 | $158.49 | $158.49 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,122.02 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,122.02 | $1,122.02 |
Where Maine sits
The same service costs 5.0 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
$1,778
AK $4,467TX $891
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.