How much rates vary
Facilitymedian $2,239 · 10th to 90th $1,000 to $3,890Professionalmedian $525 · 10th to 90th $398 to $794
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $407.38 Median $489.78 Typical High $489.78 | Professional | None | $407.38 | $489.78 | $489.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $398.11 Median $549.54 Typical High $831.76 | Professional | None | $398.11 | $549.54 | $831.76 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $602.56 Median $794.33 Typical High $1,174.90 | Professional | 50 · Both sides | $602.56 | $794.33 | $1,174.90 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $251.19 Median $331.13 Typical High $501.19 | Professional | 62 · Two surgeons | $251.19 | $331.13 | $501.19 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $64.57 Median $83.18 Typical High $125.89 | Professional | 80 · Assistant surgeon | $64.57 | $83.18 | $125.89 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $56.23 Median $72.44 Typical High $109.65 | Professional | AS · PA/NP assist | $56.23 | $72.44 | $109.65 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $2,344.23 Typical High $3,162.28 | Facility | None | $1,000.00 | $2,344.23 | $3,162.28 |
Cigna Setting Professional Modifier None Typical Low $457.09 Median $588.84 Typical High $912.01 | Professional | None | $457.09 | $588.84 | $912.01 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $407.38 Median $537.03 Typical High $812.83 | Professional | None | $407.38 | $537.03 | $812.83 |
Martin's Point Setting Professional Modifier None Typical Low $407.38 Median $489.78 Typical High $489.78 | Professional | None | $407.38 | $489.78 | $489.78 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
United Setting Professional Modifier None Typical Low $398.11 Median $537.03 Typical High $812.83 | Professional | None | $398.11 | $537.03 | $812.83 |
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 $208.93 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $208.93 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $97.72 Typical High $97.72 | Professional | 53 · Discontinued | $83.18 | $97.72 | $97.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $363.08 Typical High $363.08 | Professional | 54 · Surgery only | $309.03 | $363.08 | $363.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $63.10 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $63.10 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $48.98 Typical High $48.98 | Professional | 56 · Pre-op care only | $41.69 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $338.84 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $288.40 | $338.84 | $338.84 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $223.87 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $223.87 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $89.13 Median $97.72 Typical High $97.72 | Professional | 53 · Discontinued | $89.13 | $97.72 | $97.72 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $331.13 Median $363.08 Typical High $363.08 | Professional | 54 · Surgery only | $331.13 | $363.08 | $363.08 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $66.07 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $44.67 Median $48.98 Typical High $48.98 | Professional | 56 · Pre-op care only | $44.67 | $48.98 | $48.98 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $309.03 Median $338.84 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $309.03 | $338.84 | $338.84 |
Where Maine sits
The same service costs 5.6 times more in Alaska than in Utah. 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· 28th of 51
$537
AK $1,660UT $295
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.