How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $2,344 · 10th to 90th $1,905 to $3,715
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 $1,862.09 Median $2,238.72 Typical High $2,238.72 | Professional | None | $1,862.09 | $2,238.72 | $2,238.72 |
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 $1,905.46 Median $2,570.40 Typical High $3,715.35 | Professional | None | $1,905.46 | $2,570.40 | $3,715.35 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,202.26 Median $1,621.81 Typical High $2,344.23 | Professional | 62 · Two surgeons | $1,202.26 | $1,621.81 | $2,344.23 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $302.00 Median $416.87 Typical High $602.56 | Professional | 80 · Assistant surgeon | $302.00 | $416.87 | $602.56 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $263.03 Median $363.08 Typical High $524.81 | Professional | AS · PA/NP assist | $263.03 | $363.08 | $524.81 |
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 $2,089.30 Median $2,344.23 Typical High $3,630.78 | Professional | None | $2,089.30 | $2,344.23 | $3,630.78 |
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 $1,862.09 Median $2,398.83 Typical High $3,548.13 | Professional | None | $1,862.09 | $2,398.83 | $3,548.13 |
Martin's Point Setting Professional Modifier None Typical Low $1,949.84 Median $2,238.72 Typical High $2,238.72 | Professional | None | $1,949.84 | $2,238.72 | $2,238.72 |
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 $1,778.28 Median $2,398.83 Typical High $3,235.94 | Professional | None | $1,778.28 | $2,398.83 | $3,235.94 |
12 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 $977.24 Median $1,096.48 Typical High $1,096.48 | Professional | 52 · Reduced service | $977.24 | $1,096.48 | $1,096.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $446.68 Typical High $446.68 | Professional | 53 · Discontinued | $389.05 | $446.68 | $446.68 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,659.59 Typical High $1,659.59 | Professional | 54 · Surgery only | $1,445.44 | $1,659.59 | $1,659.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $331.13 Typical High $331.13 | Professional | 55 · Aftercare only | $288.40 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $223.87 Typical High $223.87 | Professional | 56 · Pre-op care only | $194.98 | $223.87 | $223.87 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,548.82 Typical High $1,548.82 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,548.82 | $1,548.82 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,096.48 Median $1,096.48 Typical High $1,096.48 | Professional | 52 · Reduced service | $1,096.48 | $1,096.48 | $1,096.48 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $436.52 Median $446.68 Typical High $446.68 | Professional | 53 · Discontinued | $436.52 | $446.68 | $446.68 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,621.81 Median $1,659.59 Typical High $1,659.59 | Professional | 54 · Surgery only | $1,621.81 | $1,659.59 | $1,659.59 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $323.59 Median $331.13 Typical High $331.13 | Professional | 55 · Aftercare only | $323.59 | $331.13 | $331.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $218.78 Median $223.87 Typical High $223.87 | Professional | 56 · Pre-op care only | $218.78 | $223.87 | $223.87 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,513.56 Median $1,548.82 Typical High $1,548.82 | Professional | 78 · Unplanned return to OR | $1,513.56 | $1,548.82 | $1,548.82 |
Where Maine sits
The same service costs 14.0 times more in Maine 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.
Physician feeFacility fee
ME $34,704TX $2,477
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.