How much rates vary
Facilitymedian $32,359 · 10th to 90th $776 to $33,113Professionalmedian $2,239 · 10th to 90th $1,820 to $3,631
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 $1,819.70 Median $2,089.30 Typical High $2,089.30 | Professional | None | $1,819.70 | $2,089.30 | $2,089.30 |
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 $1,819.70 Median $2,398.83 Typical High $3,630.78 | Professional | None | $1,819.70 | $2,398.83 | $3,630.78 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,148.15 Median $1,513.56 Typical High $2,290.87 | Professional | 62 · Two surgeons | $1,148.15 | $1,513.56 | $2,290.87 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $295.12 Median $389.05 Typical High $575.44 | Professional | 80 · Assistant surgeon | $295.12 | $389.05 | $575.44 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $257.04 Median $331.13 Typical High $501.19 | Professional | AS · PA/NP assist | $257.04 | $331.13 | $501.19 |
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 $1,995.26 Median $2,238.72 Typical High $3,467.37 | Professional | None | $1,995.26 | $2,238.72 | $3,467.37 |
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 $1,737.80 Median $2,290.87 Typical High $3,548.13 | Professional | None | $1,737.80 | $2,290.87 | $3,548.13 |
Martin's Point Setting Professional Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Professional | None | $2,089.30 | $2,089.30 | $2,089.30 |
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 $1,621.81 Median $2,187.76 Typical High $3,019.95 | Professional | None | $1,621.81 | $2,187.76 | $3,019.95 |
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 $912.01 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $912.01 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $363.08 Median $416.87 Typical High $416.87 | Professional | 53 · Discontinued | $363.08 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,348.96 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,348.96 | $1,584.89 | $1,584.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $316.23 Typical High $316.23 | Professional | 55 · Aftercare only | $269.15 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $181.97 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $181.97 | $208.93 | $208.93 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,258.93 | $1,479.11 | $1,479.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,047.13 Median $1,047.13 Typical High $1,047.13 | Professional | 52 · Reduced service | $1,047.13 | $1,047.13 | $1,047.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | 53 · Discontinued | $416.87 | $416.87 | $416.87 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,548.82 Median $1,584.89 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,548.82 | $1,584.89 | $1,584.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $309.03 Median $316.23 Typical High $316.23 | Professional | 55 · Aftercare only | $309.03 | $316.23 | $316.23 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $208.93 Median $208.93 Typical High $208.93 | Professional | 56 · Pre-op care only | $208.93 | $208.93 | $208.93 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $1,479.11 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,445.44 | $1,479.11 | $1,479.11 |
Where Maine sits
The same service costs 22.9 times more in Alaska 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.
Maine· 31st of 51
$2,239
AK $7,586TX $331
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.