How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $2,344 · 10th to 90th $1,738 to $3,388
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 $1,778.28 Median $2,137.96 Typical High $2,137.96 | Professional | None | $1,778.28 | $2,137.96 | $2,137.96 |
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 $1,737.80 Median $2,398.83 Typical High $3,630.78 | Professional | None | $1,737.80 | $2,398.83 | $3,630.78 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,096.48 Median $1,412.54 Typical High $2,137.96 | Professional | 62 · Two surgeons | $1,096.48 | $1,412.54 | $2,137.96 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $275.42 Median $363.08 Typical High $549.54 | Professional | 80 · Assistant surgeon | $275.42 | $363.08 | $549.54 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $245.47 Median $316.23 Typical High $478.63 | Professional | AS · PA/NP assist | $245.47 | $316.23 | $478.63 |
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 $1,862.09 Median $2,570.40 Typical High $3,890.45 | Professional | None | $1,862.09 | $2,570.40 | $3,890.45 |
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 $1,778.28 Median $2,398.83 Typical High $3,388.44 | Professional | None | $1,778.28 | $2,398.83 | $3,388.44 |
Martin's Point Setting Professional Modifier None Typical Low $2,089.30 Median $2,137.96 Typical High $2,137.96 | Professional | None | $2,089.30 | $2,137.96 | $2,137.96 |
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 $1,737.80 Median $2,511.89 Typical High $3,467.37 | Professional | None | $1,737.80 | $2,511.89 | $3,467.37 |
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 $891.25 Median $1,071.52 Typical High $1,071.52 | Professional | 52 · Reduced service | $891.25 | $1,071.52 | $1,071.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $354.81 Median $426.58 Typical High $426.58 | Professional | 53 · Discontinued | $354.81 | $426.58 | $426.58 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,348.96 Median $1,621.81 Typical High $1,621.81 | Professional | 54 · Surgery only | $1,348.96 | $1,621.81 | $1,621.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $323.59 Typical High $323.59 | Professional | 55 · Aftercare only | $269.15 | $323.59 | $323.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $177.83 Median $213.80 Typical High $213.80 | Professional | 56 · Pre-op care only | $177.83 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $1,513.56 Typical High $1,513.56 | Professional | 78 · Unplanned return to OR | $1,258.93 | $1,513.56 | $1,513.56 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,047.13 Median $1,071.52 Typical High $1,071.52 | Professional | 52 · Reduced service | $1,047.13 | $1,071.52 | $1,071.52 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $416.87 Median $426.58 Typical High $426.58 | Professional | 53 · Discontinued | $416.87 | $426.58 | $426.58 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,548.82 Median $1,621.81 Typical High $1,621.81 | Professional | 54 · Surgery only | $1,548.82 | $1,621.81 | $1,621.81 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $309.03 Median $323.59 Typical High $323.59 | Professional | 55 · Aftercare only | $309.03 | $323.59 | $323.59 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $208.93 Median $213.80 Typical High $213.80 | Professional | 56 · Pre-op care only | $208.93 | $213.80 | $213.80 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $1,513.56 Typical High $1,513.56 | Professional | 78 · Unplanned return to OR | $1,445.44 | $1,513.56 | $1,513.56 |
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· 24th of 51
$2,399
AK $6,166TX $1,148
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.