How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $3,388 · 10th to 90th $2,399 to $4,786
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 $2,511.89 Median $2,818.38 Typical High $2,818.38 | Professional | None | $2,511.89 | $2,818.38 | $2,818.38 |
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 $2,344.23 Median $3,548.13 Typical High $4,786.30 | Professional | None | $2,344.23 | $3,548.13 | $4,786.30 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,479.11 Median $2,238.72 Typical High $3,019.95 | Professional | 62 · Two surgeons | $1,479.11 | $2,238.72 | $3,019.95 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $380.19 Median $575.44 Typical High $758.58 | Professional | 80 · Assistant surgeon | $380.19 | $575.44 | $758.58 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $331.13 Median $501.19 Typical High $660.69 | Professional | AS · PA/NP assist | $331.13 | $501.19 | $660.69 |
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 $2,951.21 Median $3,090.30 Typical High $5,248.07 | Professional | None | $2,951.21 | $3,090.30 | $5,248.07 |
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 $2,570.40 Median $3,548.13 Typical High $4,677.35 | Professional | None | $2,570.40 | $3,548.13 | $4,677.35 |
Martin's Point Setting Professional Modifier None Typical Low $2,511.89 Median $2,818.38 Typical High $2,818.38 | Professional | None | $2,511.89 | $2,818.38 | $2,818.38 |
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 $2,398.83 Median $3,715.35 Typical High $4,677.35 | Professional | None | $2,398.83 | $3,715.35 | $4,677.35 |
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 $1,412.54 Median $1,412.54 Typical High $1,412.54 | Professional | 52 · Reduced service | $1,412.54 | $1,412.54 | $1,412.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $562.34 Median $562.34 Typical High $562.34 | Professional | 53 · Discontinued | $562.34 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Professional | 54 · Surgery only | $2,089.30 | $2,089.30 | $2,089.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | 55 · Aftercare only | $416.87 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | 56 · Pre-op care only | $281.84 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,949.84 Median $1,949.84 Typical High $1,949.84 | Professional | 78 · Unplanned return to OR | $1,949.84 | $1,949.84 | $1,949.84 |
Where Maine sits
The same service costs 12.4 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 $35,748WA $2,885
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.