How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $2,754 · 10th to 90th $2,239 to $4,365
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 $2,187.76 Median $2,630.27 Typical High $2,630.27 | Professional | None | $2,187.76 | $2,630.27 | $2,630.27 |
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 $2,238.72 Median $2,951.21 Typical High $4,365.16 | Professional | None | $2,238.72 | $2,951.21 | $4,365.16 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,412.54 Median $1,862.09 Typical High $2,754.23 | Professional | 62 · Two surgeons | $1,412.54 | $1,862.09 | $2,754.23 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $363.08 Median $467.74 Typical High $707.95 | Professional | 80 · Assistant surgeon | $363.08 | $467.74 | $707.95 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $316.23 Median $407.38 Typical High $616.60 | Professional | AS · PA/NP assist | $316.23 | $407.38 | $616.60 |
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 $2,454.71 Median $2,754.23 Typical High $4,265.80 | Professional | None | $2,454.71 | $2,754.23 | $4,265.80 |
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 $2,187.76 Median $2,818.38 Typical High $4,168.69 | Professional | None | $2,187.76 | $2,818.38 | $4,168.69 |
Martin's Point Setting Professional Modifier None Typical Low $2,187.76 Median $2,630.27 Typical High $2,630.27 | Professional | None | $2,187.76 | $2,630.27 | $2,630.27 |
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 $2,818.38 Typical High $3,801.89 | Professional | None | $2,137.96 | $2,818.38 | $3,801.89 |
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 $1,148.15 Median $1,318.26 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,148.15 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $467.74 Median $524.81 Typical High $524.81 | Professional | 53 · Discontinued | $467.74 | $524.81 | $524.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,737.80 Median $1,949.84 Typical High $1,949.84 | Professional | 54 · Surgery only | $1,737.80 | $1,949.84 | $1,949.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $346.74 Median $389.05 Typical High $389.05 | Professional | 55 · Aftercare only | $346.74 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $229.09 Median $263.03 Typical High $263.03 | Professional | 56 · Pre-op care only | $229.09 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,621.81 Median $1,819.70 Typical High $1,819.70 | Professional | 78 · Unplanned return to OR | $1,621.81 | $1,819.70 | $1,819.70 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,288.25 Median $1,318.26 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,288.25 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $512.86 Median $524.81 Typical High $524.81 | Professional | 53 · Discontinued | $512.86 | $524.81 | $524.81 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,905.46 Median $1,949.84 Typical High $1,949.84 | Professional | 54 · Surgery only | $1,905.46 | $1,949.84 | $1,949.84 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $380.19 Median $389.05 Typical High $389.05 | Professional | 55 · Aftercare only | $380.19 | $389.05 | $389.05 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $257.04 Median $263.03 Typical High $263.03 | Professional | 56 · Pre-op care only | $257.04 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,778.28 Median $1,819.70 Typical High $1,819.70 | Professional | 78 · Unplanned return to OR | $1,778.28 | $1,819.70 | $1,819.70 |
Where Maine sits
The same service costs 13.8 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 $35,114TX $2,545
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.