How much rates vary
Facilitymedian $2,239 · 10th to 90th $1,000 to $3,890Professionalmedian $794 · 10th to 90th $603 to $1,175
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 $616.60 Median $741.31 Typical High $741.31 | Professional | None | $616.60 | $741.31 | $741.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $602.56 Median $831.76 Typical High $1,258.93 | Professional | None | $602.56 | $831.76 | $1,258.93 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $912.01 Median $1,174.90 Typical High $1,778.28 | Professional | 50 · Both sides | $912.01 | $1,174.90 | $1,778.28 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $380.19 Median $489.78 Typical High $741.31 | Professional | 62 · Two surgeons | $380.19 | $489.78 | $741.31 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $97.72 Median $125.89 Typical High $190.55 | Professional | 80 · Assistant surgeon | $97.72 | $125.89 | $190.55 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $85.11 Median $109.65 Typical High $165.96 | Professional | AS · PA/NP assist | $85.11 | $109.65 | $165.96 |
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 $676.08 Median $891.25 Typical High $1,348.96 | Professional | None | $676.08 | $891.25 | $1,348.96 |
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 $616.60 Median $851.14 Typical High $1,202.26 | Professional | None | $616.60 | $851.14 | $1,202.26 |
Martin's Point Setting Professional Modifier None Typical Low $630.96 Median $741.31 Typical High $741.31 | Professional | None | $630.96 | $741.31 | $741.31 |
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 $602.56 Median $851.14 Typical High $1,202.26 | Professional | None | $602.56 | $851.14 | $1,202.26 |
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 $316.23 Median $371.54 Typical High $371.54 | Professional | 52 · Reduced service | $316.23 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $125.89 Median $147.91 Typical High $147.91 | Professional | 53 · Discontinued | $125.89 | $147.91 | $147.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $467.74 Median $549.54 Typical High $549.54 | Professional | 54 · Surgery only | $467.74 | $549.54 | $549.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $93.33 Median $109.65 Typical High $109.65 | Professional | 55 · Aftercare only | $93.33 | $109.65 | $109.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $63.10 Median $74.13 Typical High $74.13 | Professional | 56 · Pre-op care only | $63.10 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $436.52 Median $512.86 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $436.52 | $512.86 | $512.86 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $363.08 Median $371.54 Typical High $371.54 | Professional | 52 · Reduced service | $363.08 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $147.91 Typical High $147.91 | Professional | 53 · Discontinued | $144.54 | $147.91 | $147.91 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $549.54 Typical High $549.54 | Professional | 54 · Surgery only | $549.54 | $549.54 | $549.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | 55 · Aftercare only | $109.65 | $109.65 | $109.65 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $74.13 Typical High $74.13 | Professional | 56 · Pre-op care only | $72.44 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $512.86 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $512.86 | $512.86 | $512.86 |
Where Maine sits
The same service costs 5.9 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· 26th of 51
$813
AK $2,512TX $427
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.