How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $3,548 · 10th to 90th $2,570 to $5,012
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 $2,630.27 Median $2,951.21 Typical High $2,951.21 | Professional | None | $2,630.27 | $2,951.21 | $2,951.21 |
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 $2,511.89 Median $3,801.89 Typical High $5,011.87 | Professional | None | $2,511.89 | $3,801.89 | $5,011.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,584.89 Median $2,398.83 Typical High $3,162.28 | Professional | 62 · Two surgeons | $1,584.89 | $2,398.83 | $3,162.28 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $398.11 Median $602.56 Typical High $812.83 | Professional | 80 · Assistant surgeon | $398.11 | $602.56 | $812.83 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $346.74 Median $524.81 Typical High $707.95 | Professional | AS · PA/NP assist | $346.74 | $524.81 | $707.95 |
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 $3,090.30 Median $3,235.94 Typical High $5,623.41 | Professional | None | $3,090.30 | $3,235.94 | $5,623.41 |
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 $2,951.21 Median $3,715.35 Typical High $4,897.79 | Professional | None | $2,951.21 | $3,715.35 | $4,897.79 |
Martin's Point Setting Professional Modifier None Typical Low $2,630.27 Median $2,951.21 Typical High $2,951.21 | Professional | None | $2,630.27 | $2,951.21 | $2,951.21 |
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 $2,818.38 Median $3,981.07 Typical High $5,011.87 | Professional | None | $2,818.38 | $3,981.07 | $5,011.87 |
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 $1,479.11 Median $1,479.11 Typical High $1,479.11 | Professional | 52 · Reduced service | $1,479.11 | $1,479.11 | $1,479.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $588.84 Median $588.84 Typical High $588.84 | Professional | 53 · Discontinued | $588.84 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,187.76 Median $2,187.76 Typical High $2,187.76 | Professional | 54 · Surgery only | $2,187.76 | $2,187.76 | $2,187.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $436.52 Median $436.52 Typical High $436.52 | Professional | 55 · Aftercare only | $436.52 | $436.52 | $436.52 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $295.12 Median $295.12 Typical High $295.12 | Professional | 56 · Pre-op care only | $295.12 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,041.74 Median $2,041.74 Typical High $2,041.74 | Professional | 78 · Unplanned return to OR | $2,041.74 | $2,041.74 | $2,041.74 |
Where Maine sits
The same service costs 12.3 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 $35,907WA $2,929
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.