How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $1,778 · 10th to 90th $1,318 to $2,630
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 $1,348.96 Median $1,621.81 Typical High $1,621.81 | Professional | None | $1,348.96 | $1,621.81 | $1,621.81 |
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 $1,318.26 Median $1,819.70 Typical High $2,754.23 | Professional | None | $1,318.26 | $1,819.70 | $2,754.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $831.76 Median $1,071.52 Typical High $1,621.81 | Professional | 62 · Two surgeons | $831.76 | $1,071.52 | $1,621.81 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $208.93 Median $275.42 Typical High $416.87 | Professional | 80 · Assistant surgeon | $208.93 | $275.42 | $416.87 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $186.21 Median $239.88 Typical High $363.08 | Professional | AS · PA/NP assist | $186.21 | $239.88 | $363.08 |
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 $1,445.44 Median $1,949.84 Typical High $2,951.21 | Professional | None | $1,445.44 | $1,949.84 | $2,951.21 |
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 $1,348.96 Median $1,819.70 Typical High $2,630.27 | Professional | None | $1,348.96 | $1,819.70 | $2,630.27 |
Martin's Point Setting Professional Modifier None Typical Low $1,584.89 Median $1,621.81 Typical High $1,621.81 | Professional | None | $1,584.89 | $1,621.81 | $1,621.81 |
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 $1,318.26 Median $1,862.09 Typical High $2,630.27 | Professional | None | $1,318.26 | $1,862.09 | $2,630.27 |
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 $676.08 Median $812.83 Typical High $812.83 | Professional | 52 · Reduced service | $676.08 | $812.83 | $812.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $323.59 Typical High $323.59 | Professional | 53 · Discontinued | $269.15 | $323.59 | $323.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,230.27 Typical High $1,230.27 | Professional | 54 · Surgery only | $1,023.29 | $1,230.27 | $1,230.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $245.47 Typical High $245.47 | Professional | 55 · Aftercare only | $204.17 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $162.18 Typical High $162.18 | Professional | 56 · Pre-op care only | $134.90 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $1,148.15 Typical High $1,148.15 | Professional | 78 · Unplanned return to OR | $954.99 | $1,148.15 | $1,148.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $794.33 Median $812.83 Typical High $812.83 | Professional | 52 · Reduced service | $794.33 | $812.83 | $812.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $323.59 Typical High $323.59 | Professional | 53 · Discontinued | $316.23 | $323.59 | $323.59 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,230.27 Typical High $1,230.27 | Professional | 54 · Surgery only | $1,174.90 | $1,230.27 | $1,230.27 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $245.47 Typical High $245.47 | Professional | 55 · Aftercare only | $239.88 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $162.18 Typical High $162.18 | Professional | 56 · Pre-op care only | $158.49 | $162.18 | $162.18 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,148.15 Typical High $1,148.15 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,148.15 | $1,148.15 |
Where Maine sits
The same service costs 5.4 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
$1,820
AK $4,677TX $871
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.