How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $2,951 · 10th to 90th $2,239 to $4,365
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 $2,290.87 Median $2,754.23 Typical High $2,754.23 | Professional | None | $2,290.87 | $2,754.23 | $2,754.23 |
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 $2,238.72 Median $3,090.30 Typical High $4,677.35 | Professional | None | $2,238.72 | $3,090.30 | $4,677.35 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,412.54 Median $1,819.70 Typical High $2,754.23 | Professional | 62 · Two surgeons | $1,412.54 | $1,819.70 | $2,754.23 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $354.81 Median $467.74 Typical High $707.95 | Professional | 80 · Assistant surgeon | $354.81 | $467.74 | $707.95 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $316.23 Median $407.38 Typical High $616.60 | Professional | AS · PA/NP assist | $316.23 | $407.38 | $616.60 |
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 $2,398.83 Median $3,311.31 Typical High $5,011.87 | Professional | None | $2,398.83 | $3,311.31 | $5,011.87 |
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 $2,238.72 Median $3,019.95 Typical High $4,365.16 | Professional | None | $2,238.72 | $3,019.95 | $4,365.16 |
Martin's Point Setting Professional Modifier None Typical Low $2,630.27 Median $2,754.23 Typical High $2,754.23 | Professional | None | $2,630.27 | $2,754.23 | $2,754.23 |
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 $2,238.72 Median $3,162.28 Typical High $4,466.84 | Professional | None | $2,238.72 | $3,162.28 | $4,466.84 |
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 $1,148.15 Median $1,380.38 Typical High $1,380.38 | Professional | 52 · Reduced service | $1,148.15 | $1,380.38 | $1,380.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $467.74 Median $549.54 Typical High $549.54 | Professional | 53 · Discontinued | $467.74 | $549.54 | $549.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,737.80 Median $2,089.30 Typical High $2,089.30 | Professional | 54 · Surgery only | $1,737.80 | $2,089.30 | $2,089.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $346.74 Median $416.87 Typical High $416.87 | Professional | 55 · Aftercare only | $346.74 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $229.09 Median $275.42 Typical High $275.42 | Professional | 56 · Pre-op care only | $229.09 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,621.81 Median $1,949.84 Typical High $1,949.84 | Professional | 78 · Unplanned return to OR | $1,621.81 | $1,949.84 | $1,949.84 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,318.26 Median $1,380.38 Typical High $1,380.38 | Professional | 52 · Reduced service | $1,318.26 | $1,380.38 | $1,380.38 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $524.81 Median $549.54 Typical High $549.54 | Professional | 53 · Discontinued | $524.81 | $549.54 | $549.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,995.26 Median $2,089.30 Typical High $2,089.30 | Professional | 54 · Surgery only | $1,995.26 | $2,089.30 | $2,089.30 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $398.11 Median $416.87 Typical High $416.87 | Professional | 55 · Aftercare only | $398.11 | $416.87 | $416.87 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $263.03 Median $275.42 Typical High $275.42 | Professional | 56 · Pre-op care only | $263.03 | $275.42 | $275.42 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,862.09 Median $1,949.84 Typical High $1,949.84 | Professional | 78 · Unplanned return to OR | $1,862.09 | $1,949.84 | $1,949.84 |
Where Maine sits
The same service costs 22.4 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
$3,020
AK $7,943TX $355
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.