How much rates vary
Facilitymedian $7,762 · 10th to 90th $776 to $33,113Professionalmedian $3,020 · 10th to 90th $2,089 to $5,370
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 Facility Modifier None Typical Low $2,398.83 Median $2,398.83 Typical High $9,772.37 | Facility | None | $2,398.83 | $2,398.83 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $1,949.84 Median $2,691.53 Typical High $2,691.53 | Professional | None | $1,949.84 | $2,691.53 | $2,691.53 |
Anthem BCBS Setting Facility Modifier None Typical Low $9,772.37 Median $19,952.62 Typical High $34,673.69 | Facility | None | $9,772.37 | $19,952.62 | $34,673.69 |
Anthem BCBS Setting Professional Modifier None Typical Low $2,570.40 Median $3,715.35 Typical High $5,370.32 | Professional | None | $2,570.40 | $3,715.35 | $5,370.32 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,621.81 Median $2,344.23 Typical High $3,388.44 | Professional | 62 · Two surgeons | $1,621.81 | $2,344.23 | $3,388.44 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $407.38 Median $602.56 Typical High $870.96 | Professional | 80 · Assistant surgeon | $407.38 | $602.56 | $870.96 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $354.81 Median $524.81 Typical High $758.58 | Professional | AS · PA/NP assist | $354.81 | $524.81 | $758.58 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $630.96 Typical High $2,691.53 | Facility | None | $489.78 | $630.96 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $2,454.71 Median $3,019.95 Typical High $5,888.44 | Professional | None | $2,454.71 | $3,019.95 | $5,888.44 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $851.14 Typical High $2,884.03 | Facility | None | $776.25 | $851.14 | $2,884.03 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,995.26 Median $2,951.21 Typical High $5,754.40 | Professional | None | $1,995.26 | $2,951.21 | $5,754.40 |
United Setting Facility Modifier None Typical Low $776.25 Median $933.25 Typical High $2,884.03 | Facility | None | $776.25 | $933.25 | $2,884.03 |
United Setting Professional Modifier None Typical Low $2,089.30 Median $2,630.27 Typical High $4,786.30 | Professional | None | $2,089.30 | $2,630.27 | $4,786.30 |
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 $977.24 Median $1,348.96 Typical High $1,348.96 | Professional | 52 · Reduced service | $977.24 | $1,348.96 | $1,348.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $537.03 Typical High $537.03 | Professional | 53 · Discontinued | $389.05 | $537.03 | $537.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,995.26 Typical High $1,995.26 | Professional | 54 · Surgery only | $1,445.44 | $1,995.26 | $1,995.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $398.11 Typical High $398.11 | Professional | 55 · Aftercare only | $288.40 | $398.11 | $398.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $269.15 Typical High $269.15 | Professional | 56 · Pre-op care only | $194.98 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,862.09 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,862.09 | $1,862.09 |
Where New Hampshire 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.