How much rates vary
Facilitymedian $26,303 · 10th to 90th $776 to $26,915Professionalmedian $1,862 · 10th to 90th $1,318 to $2,512
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 $1,380.38 Median $1,737.80 Typical High $2,344.23 | Professional | None | $1,380.38 | $1,737.80 | $2,344.23 |
Anthem BCBS Setting Facility Modifier None Typical Low $20,892.96 Median $26,915.35 Typical High $27,542.29 | Facility | None | $20,892.96 | $26,915.35 | $27,542.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,202.26 Median $1,905.46 Typical High $2,511.89 | Professional | None | $1,202.26 | $1,905.46 | $2,511.89 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,778.28 Median $2,818.38 Typical High $3,801.89 | Professional | 50 · Both sides | $1,778.28 | $2,818.38 | $3,801.89 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $758.58 Median $1,202.26 Typical High $1,584.89 | Professional | 62 · Two surgeons | $758.58 | $1,202.26 | $1,584.89 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $190.55 Median $302.00 Typical High $407.38 | Professional | 80 · Assistant surgeon | $190.55 | $302.00 | $407.38 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $165.96 Median $263.03 Typical High $354.81 | Professional | AS · PA/NP assist | $165.96 | $263.03 | $354.81 |
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 $1,737.80 Median $1,819.70 Typical High $2,951.21 | Professional | None | $1,737.80 | $1,819.70 | $2,951.21 |
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 $1,479.11 Median $1,905.46 Typical High $2,454.71 | Professional | None | $1,479.11 | $1,905.46 | $2,454.71 |
Martin's Point Setting Professional Modifier None Typical Low $1,380.38 Median $1,737.80 Typical High $2,344.23 | Professional | None | $1,380.38 | $1,737.80 | $2,344.23 |
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 $1,479.11 Median $2,089.30 Typical High $2,630.27 | Professional | None | $1,479.11 | $2,089.30 | $2,630.27 |
6 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 $870.96 Median $870.96 Typical High $870.96 | Professional | 52 · Reduced service | $870.96 | $870.96 | $870.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $346.74 Median $346.74 Typical High $346.74 | Professional | 53 · Discontinued | $346.74 | $346.74 | $346.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,288.25 Median $1,288.25 Typical High $1,288.25 | Professional | 54 · Surgery only | $1,288.25 | $1,288.25 | $1,288.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $257.04 Typical High $257.04 | Professional | 55 · Aftercare only | $257.04 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | 56 · Pre-op care only | $173.78 | $173.78 | $173.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $1,202.26 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $1,202.26 | $1,202.26 | $1,202.26 |
Where Maine sits
The same service costs 13.9 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 $28,165MD $2,021
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.