How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $2,818 · 10th to 90th $2,239 to $4,467
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 $2,238.72 Median $2,691.53 Typical High $2,691.53 | Professional | None | $2,238.72 | $2,691.53 | $2,691.53 |
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 $2,290.87 Median $2,951.21 Typical High $4,466.84 | Professional | None | $2,290.87 | $2,951.21 | $4,466.84 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,445.44 Median $1,862.09 Typical High $2,818.38 | Professional | 62 · Two surgeons | $1,445.44 | $1,862.09 | $2,818.38 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $363.08 Median $478.63 Typical High $724.44 | Professional | 80 · Assistant surgeon | $363.08 | $478.63 | $724.44 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $316.23 Median $416.87 Typical High $630.96 | Professional | AS · PA/NP assist | $316.23 | $416.87 | $630.96 |
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 $2,511.89 Median $2,818.38 Typical High $4,365.16 | Professional | None | $2,511.89 | $2,818.38 | $4,365.16 |
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 $2,238.72 Median $2,884.03 Typical High $4,265.80 | Professional | None | $2,238.72 | $2,884.03 | $4,265.80 |
Martin's Point Setting Professional Modifier None Typical Low $2,238.72 Median $2,691.53 Typical High $2,691.53 | Professional | None | $2,238.72 | $2,691.53 | $2,691.53 |
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 $2,137.96 Median $2,884.03 Typical High $3,890.45 | Professional | None | $2,137.96 | $2,884.03 | $3,890.45 |
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 $1,174.90 Median $1,318.26 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,174.90 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $467.74 Median $537.03 Typical High $537.03 | Professional | 53 · Discontinued | $467.74 | $537.03 | $537.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,778.28 Median $1,995.26 Typical High $1,995.26 | Professional | 54 · Surgery only | $1,778.28 | $1,995.26 | $1,995.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $354.81 Median $398.11 Typical High $398.11 | Professional | 55 · Aftercare only | $354.81 | $398.11 | $398.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $234.42 Median $269.15 Typical High $269.15 | Professional | 56 · Pre-op care only | $234.42 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,659.59 Median $1,862.09 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $1,659.59 | $1,862.09 | $1,862.09 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,318.26 Median $1,318.26 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,318.26 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $524.81 Median $537.03 Typical High $537.03 | Professional | 53 · Discontinued | $524.81 | $537.03 | $537.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,949.84 Median $1,995.26 Typical High $1,995.26 | Professional | 54 · Surgery only | $1,949.84 | $1,995.26 | $1,995.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $389.05 Median $398.11 Typical High $398.11 | Professional | 55 · Aftercare only | $389.05 | $398.11 | $398.11 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $263.03 Median $269.15 Typical High $269.15 | Professional | 56 · Pre-op care only | $263.03 | $269.15 | $269.15 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,819.70 Median $1,862.09 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $1,819.70 | $1,862.09 | $1,862.09 |
Where Maine sits
The same service costs 12.4 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 $35,178WA $2,843
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.