How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $1,445 · 10th to 90th $1,096 to $2,138
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 $1,122.02 Median $1,318.26 Typical High $1,318.26 | Professional | None | $1,122.02 | $1,318.26 | $1,318.26 |
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 $1,096.48 Median $1,479.11 Typical High $2,290.87 | Professional | None | $1,096.48 | $1,479.11 | $2,290.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $676.08 Median $891.25 Typical High $1,348.96 | Professional | 62 · Two surgeons | $676.08 | $891.25 | $1,348.96 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $173.78 Median $223.87 Typical High $338.84 | Professional | 80 · Assistant surgeon | $173.78 | $223.87 | $338.84 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $151.36 Median $194.98 Typical High $295.12 | Professional | AS · PA/NP assist | $151.36 | $194.98 | $295.12 |
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 $1,202.26 Median $1,584.89 Typical High $2,454.71 | Professional | None | $1,202.26 | $1,584.89 | $2,454.71 |
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 $1,096.48 Median $1,513.56 Typical High $2,137.96 | Professional | None | $1,096.48 | $1,513.56 | $2,137.96 |
Martin's Point Setting Professional Modifier None Typical Low $1,288.25 Median $1,318.26 Typical High $1,318.26 | Professional | None | $1,288.25 | $1,318.26 | $1,318.26 |
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 $1,071.52 Median $1,548.82 Typical High $2,187.76 | Professional | None | $1,071.52 | $1,548.82 | $2,187.76 |
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 $562.34 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $562.34 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $223.87 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $831.76 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $165.96 | $199.53 | $199.53 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $112.20 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $776.25 | $933.25 | $933.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $645.65 Median $660.69 Typical High $660.69 | Professional | 52 · Reduced service | $645.65 | $660.69 | $660.69 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $263.03 Typical High $263.03 | Professional | 53 · Discontinued | $263.03 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $977.24 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $977.24 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $194.98 Median $199.53 Typical High $199.53 | Professional | 55 · Aftercare only | $194.98 | $199.53 | $199.53 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $128.82 Median $131.83 Typical High $131.83 | Professional | 56 · Pre-op care only | $128.82 | $131.83 | $131.83 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $912.01 | $933.25 | $933.25 |
Where Maine sits
The same service costs 10.0 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 $17,294MD $1,737
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.