How much rates vary
Facilitymedian $15,849 · 10th to 90th $776 to $16,596Professionalmedian $1,479 · 10th to 90th $1,096 to $2,188
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 $1,288.25 Median $1,348.96 Typical High $1,698.24 | Professional | None | $1,288.25 | $1,348.96 | $1,698.24 |
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 $1,513.56 Typical High $2,290.87 | Professional | None | $1,096.48 | $1,513.56 | $2,290.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $691.83 Median $912.01 Typical High $1,380.38 | Professional | 62 · Two surgeons | $691.83 | $912.01 | $1,380.38 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $177.83 Median $229.09 Typical High $346.74 | Professional | 80 · Assistant surgeon | $177.83 | $229.09 | $346.74 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $154.88 Median $199.53 Typical High $302.00 | Professional | AS · PA/NP assist | $154.88 | $199.53 | $302.00 |
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 $1,258.93 Median $1,621.81 Typical High $2,454.71 | Professional | None | $1,258.93 | $1,621.81 | $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 $1,148.15 Median $1,513.56 Typical High $2,187.76 | Professional | None | $1,148.15 | $1,513.56 | $2,187.76 |
Martin's Point Setting Professional Modifier None Typical Low $1,318.26 Median $1,348.96 Typical High $1,698.24 | Professional | None | $1,318.26 | $1,348.96 | $1,698.24 |
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 $1,096.48 Median $1,548.82 Typical High $2,187.76 | Professional | None | $1,096.48 | $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 $575.44 Median $676.08 Typical High $676.08 | Professional | 52 · Reduced service | $575.44 | $676.08 | $676.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $269.15 Typical High $269.15 | Professional | 53 · Discontinued | $229.09 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $1,023.29 Typical High $1,023.29 | Professional | 54 · Surgery only | $851.14 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $204.17 Typical High $204.17 | Professional | 55 · Aftercare only | $169.82 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $134.90 Typical High $134.90 | Professional | 56 · Pre-op care only | $114.82 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $954.99 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $794.33 | $954.99 | $954.99 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $660.69 Median $676.08 Typical High $676.08 | Professional | 52 · Reduced service | $660.69 | $676.08 | $676.08 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $269.15 Typical High $269.15 | Professional | 53 · Discontinued | $263.03 | $269.15 | $269.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,023.29 Typical High $1,023.29 | Professional | 54 · Surgery only | $1,000.00 | $1,023.29 | $1,023.29 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $204.17 Typical High $204.17 | Professional | 55 · Aftercare only | $199.53 | $204.17 | $204.17 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $134.90 Typical High $134.90 | Professional | 56 · Pre-op care only | $131.83 | $134.90 | $134.90 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $954.99 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $933.25 | $954.99 | $954.99 |
Where Maine sits
The same service costs 5.6 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· 25th of 51
$1,514
AK $4,266TX $759
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.