How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $1,514 · 10th to 90th $1,148 to $2,344
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 $1,174.90 Median $1,348.96 Typical High $1,348.96 | Professional | None | $1,174.90 | $1,348.96 | $1,348.96 |
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 $1,148.15 Median $1,659.59 Typical High $2,344.23 | Professional | None | $1,148.15 | $1,659.59 | $2,344.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $724.44 Median $1,047.13 Typical High $1,479.11 | Professional | 62 · Two surgeons | $724.44 | $1,047.13 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $181.97 Median $269.15 Typical High $371.54 | Professional | 80 · Assistant surgeon | $181.97 | $269.15 | $371.54 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $158.49 Median $234.42 Typical High $323.59 | Professional | AS · PA/NP assist | $158.49 | $234.42 | $323.59 |
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 $1,412.54 Median $1,445.44 Typical High $2,630.27 | Professional | None | $1,412.54 | $1,445.44 | $2,630.27 |
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 $1,258.93 Median $1,659.59 Typical High $2,344.23 | Professional | None | $1,258.93 | $1,659.59 | $2,344.23 |
Martin's Point Setting Professional Modifier None Typical Low $1,174.90 Median $1,348.96 Typical High $1,348.96 | Professional | None | $1,174.90 | $1,348.96 | $1,348.96 |
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 $1,174.90 Median $1,659.59 Typical High $2,344.23 | Professional | None | $1,174.90 | $1,659.59 | $2,344.23 |
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 $676.08 Median $676.08 Typical High $676.08 | Professional | 52 · Reduced service | $676.08 | $676.08 | $676.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $269.15 Typical High $269.15 | Professional | 53 · Discontinued | $269.15 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,023.29 Typical High $1,023.29 | Professional | 54 · Surgery only | $1,023.29 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | 55 · Aftercare only | $204.17 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $134.90 Typical High $134.90 | Professional | 56 · Pre-op care only | $134.90 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $954.99 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $954.99 | $954.99 | $954.99 |
Where Maine sits
The same service costs 5.6 times more in Alaska than in Utah. 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
$1,660
AK $5,012UT $891
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.