How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $2,754 · 10th to 90th $1,950 to $3,890
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 $1,995.26 Median $2,238.72 Typical High $2,238.72 | Professional | None | $1,995.26 | $2,238.72 | $2,238.72 |
Anthem BCBS Setting Facility Modifier None Typical Low $25,703.96 Median $33,113.11 Typical High $33,884.42 | Facility | None | $25,703.96 | $33,113.11 | $33,884.42 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,949.84 Median $2,884.03 Typical High $3,890.45 | Professional | None | $1,949.84 | $2,884.03 | $3,890.45 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,230.27 Median $1,819.70 Typical High $2,398.83 | Professional | 62 · Two surgeons | $1,230.27 | $1,819.70 | $2,398.83 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $309.03 Median $457.09 Typical High $616.60 | Professional | 80 · Assistant surgeon | $309.03 | $457.09 | $616.60 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $275.42 Median $407.38 Typical High $537.03 | Professional | AS · PA/NP assist | $275.42 | $407.38 | $537.03 |
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 $2,398.83 Median $2,511.89 Typical High $4,365.16 | Professional | None | $2,398.83 | $2,511.89 | $4,365.16 |
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 $2,187.76 Median $2,884.03 Typical High $3,801.89 | Professional | None | $2,187.76 | $2,884.03 | $3,801.89 |
Martin's Point Setting Professional Modifier None Typical Low $1,995.26 Median $2,238.72 Typical High $2,238.72 | Professional | None | $1,995.26 | $2,238.72 | $2,238.72 |
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 $1,995.26 Median $3,019.95 Typical High $3,890.45 | Professional | None | $1,995.26 | $3,019.95 | $3,890.45 |
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 $1,122.02 Median $1,122.02 Typical High $1,122.02 | Professional | 52 · Reduced service | $1,122.02 | $1,122.02 | $1,122.02 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $446.68 Median $446.68 Typical High $446.68 | Professional | 53 · Discontinued | $446.68 | $446.68 | $446.68 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,698.24 Median $1,698.24 Typical High $1,698.24 | Professional | 54 · Surgery only | $1,698.24 | $1,698.24 | $1,698.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $338.84 Median $338.84 Typical High $338.84 | Professional | 55 · Aftercare only | $338.84 | $338.84 | $338.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | 56 · Pre-op care only | $223.87 | $223.87 | $223.87 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,584.89 Median $1,584.89 Typical High $1,584.89 | Professional | 78 · Unplanned return to OR | $1,584.89 | $1,584.89 | $1,584.89 |
Where Maine sits
The same service costs 13.8 times more in Maine than in Washington. 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 $35,114WA $2,549
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.