How much rates vary
Facilitymedian $7,762 · 10th to 90th $776 to $33,113Professionalmedian $3,631 · 10th to 90th $2,455 to $6,310
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 $2,344.23 Median $3,235.94 Typical High $3,235.94 | Professional | None | $2,344.23 | $3,235.94 | $3,235.94 |
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 $2,951.21 Median $4,570.88 Typical High $6,606.93 | Professional | None | $2,951.21 | $4,570.88 | $6,606.93 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,862.09 Median $2,884.03 Typical High $4,168.69 | Professional | 62 · Two surgeons | $1,862.09 | $2,884.03 | $4,168.69 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $478.63 Median $724.44 Typical High $1,047.13 | Professional | 80 · Assistant surgeon | $478.63 | $724.44 | $1,047.13 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $416.87 Median $645.65 Typical High $912.01 | Professional | AS · PA/NP assist | $416.87 | $645.65 | $912.01 |
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 $2,884.03 Median $3,630.78 Typical High $6,918.31 | Professional | None | $2,884.03 | $3,630.78 | $6,918.31 |
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 $2,454.71 Median $3,388.44 Typical High $6,309.57 | Professional | None | $2,454.71 | $3,388.44 | $6,309.57 |
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 $2,511.89 Median $3,162.28 Typical High $5,754.40 | Professional | None | $2,511.89 | $3,162.28 | $5,754.40 |
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 $1,174.90 Median $1,621.81 Typical High $1,621.81 | Professional | 52 · Reduced service | $1,174.90 | $1,621.81 | $1,621.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $478.63 Median $645.65 Typical High $645.65 | Professional | 53 · Discontinued | $478.63 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,778.28 Median $2,454.71 Typical High $2,454.71 | Professional | 54 · Surgery only | $1,778.28 | $2,454.71 | $2,454.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $354.81 Median $489.78 Typical High $489.78 | Professional | 55 · Aftercare only | $354.81 | $489.78 | $489.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $239.88 Median $323.59 Typical High $323.59 | Professional | 56 · Pre-op care only | $239.88 | $323.59 | $323.59 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,659.59 Median $2,290.87 Typical High $2,290.87 | Professional | 78 · Unplanned return to OR | $1,659.59 | $2,290.87 | $2,290.87 |
Where New Hampshire 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.