How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $1,950 · 10th to 90th $1,380 to $2,754
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 $1,348.96 Median $1,621.81 Typical High $1,621.81 | Professional | None | $1,348.96 | $1,621.81 | $1,621.81 |
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 $1,380.38 Median $2,041.74 Typical High $2,754.23 | Professional | None | $1,380.38 | $2,041.74 | $2,754.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $851.14 Median $1,288.25 Typical High $1,737.80 | Professional | 62 · Two surgeons | $851.14 | $1,288.25 | $1,737.80 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $218.78 Median $323.59 Typical High $436.52 | Professional | 80 · Assistant surgeon | $218.78 | $323.59 | $436.52 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $190.55 Median $288.40 Typical High $389.05 | Professional | AS · PA/NP assist | $190.55 | $288.40 | $389.05 |
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 $1,698.24 Median $1,778.28 Typical High $3,090.30 | Professional | None | $1,698.24 | $1,778.28 | $3,090.30 |
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 $1,548.82 Median $2,041.74 Typical High $2,691.53 | Professional | None | $1,548.82 | $2,041.74 | $2,691.53 |
Martin's Point Setting Professional Modifier None Typical Low $1,348.96 Median $1,621.81 Typical High $1,621.81 | Professional | None | $1,348.96 | $1,621.81 | $1,621.81 |
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 $1,479.11 Median $2,137.96 Typical High $2,754.23 | Professional | None | $1,479.11 | $2,137.96 | $2,754.23 |
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 $812.83 Median $812.83 Typical High $812.83 | Professional | 52 · Reduced service | $812.83 | $812.83 | $812.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $323.59 Typical High $323.59 | Professional | 53 · Discontinued | $323.59 | $323.59 | $323.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,202.26 Typical High $1,202.26 | Professional | 54 · Surgery only | $1,202.26 | $1,202.26 | $1,202.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | 55 · Aftercare only | $239.88 | $239.88 | $239.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | 56 · Pre-op care only | $162.18 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,122.02 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,122.02 | $1,122.02 |
Where Maine sits
The same service costs 16.3 times more in Maine than in Maryland. 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 $34,309MD $2,111
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.