How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $3,631 · 10th to 90th $2,630 to $5,129
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 $3,019.95 Typical High $3,019.95 | Professional | None | $2,511.89 | $3,019.95 | $3,019.95 |
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 $2,570.40 Median $3,890.45 Typical High $5,128.61 | Professional | None | $2,570.40 | $3,890.45 | $5,128.61 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,584.89 Median $2,398.83 Typical High $3,235.94 | Professional | 62 · Two surgeons | $1,584.89 | $2,398.83 | $3,235.94 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $407.38 Median $616.60 Typical High $812.83 | Professional | 80 · Assistant surgeon | $407.38 | $616.60 | $812.83 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $354.81 Median $537.03 Typical High $724.44 | Professional | AS · PA/NP assist | $354.81 | $537.03 | $724.44 |
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 $3,162.28 Median $3,311.31 Typical High $5,754.40 | Professional | None | $3,162.28 | $3,311.31 | $5,754.40 |
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 $2,818.38 Median $3,801.89 Typical High $5,011.87 | Professional | None | $2,818.38 | $3,801.89 | $5,011.87 |
Martin's Point Setting Professional Modifier None Typical Low $2,511.89 Median $3,019.95 Typical High $3,019.95 | Professional | None | $2,511.89 | $3,019.95 | $3,019.95 |
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 $2,630.27 Median $4,073.80 Typical High $5,128.61 | Professional | None | $2,630.27 | $4,073.80 | $5,128.61 |
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 $1,513.56 Median $1,513.56 Typical High $1,513.56 | Professional | 52 · Reduced service | $1,513.56 | $1,513.56 | $1,513.56 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $602.56 Median $602.56 Typical High $602.56 | Professional | 53 · Discontinued | $602.56 | $602.56 | $602.56 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,290.87 Median $2,290.87 Typical High $2,290.87 | Professional | 54 · Surgery only | $2,290.87 | $2,290.87 | $2,290.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $457.09 Median $457.09 Typical High $457.09 | Professional | 55 · Aftercare only | $457.09 | $457.09 | $457.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | 56 · Pre-op care only | $302.00 | $302.00 | $302.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,137.96 Median $2,137.96 Typical High $2,137.96 | Professional | 78 · Unplanned return to OR | $2,137.96 | $2,137.96 | $2,137.96 |
Where Maine sits
The same service costs 17.0 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· 17th of 51
$3,802
AK $10,965TX $646
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.