How much rates vary
Facilitymedian $2,512 · 10th to 90th $813 to $6,761Professionalmedian $1,698 · 10th to 90th $1,349 to $2,630
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $1,412.54 Median $1,621.81 Typical High $1,621.81 | Professional | None | $1,412.54 | $1,621.81 | $1,621.81 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,348.96 Median $1,737.80 Typical High $2,630.27 | Professional | None | $1,348.96 | $1,737.80 | $2,630.27 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $851.14 Median $1,096.48 Typical High $1,659.59 | Professional | 62 · Two surgeons | $851.14 | $1,096.48 | $1,659.59 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $213.80 Median $281.84 Typical High $416.87 | Professional | 80 · Assistant surgeon | $213.80 | $281.84 | $416.87 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $186.21 Median $245.47 Typical High $363.08 | Professional | AS · PA/NP assist | $186.21 | $245.47 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $4,677.35 Typical High $7,413.10 | Facility | None | $812.83 | $4,677.35 | $7,413.10 |
Cigna Setting Professional Modifier None Typical Low $1,513.56 Median $1,698.24 Typical High $2,630.27 | Professional | None | $1,513.56 | $1,698.24 | $2,630.27 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,348.96 Median $1,698.24 Typical High $2,398.83 | Professional | None | $1,348.96 | $1,698.24 | $2,398.83 |
Martin's Point Setting Professional Modifier None Typical Low $1,548.82 Median $1,621.81 Typical High $1,621.81 | Professional | None | $1,548.82 | $1,621.81 | $1,621.81 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
United Setting Professional Modifier None Typical Low $1,318.26 Median $1,698.24 Typical High $2,290.87 | Professional | None | $1,318.26 | $1,698.24 | $2,290.87 |
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 $707.95 Median $794.33 Typical High $794.33 | Professional | 52 · Reduced service | $707.95 | $794.33 | $794.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $288.40 Median $323.59 Typical High $323.59 | Professional | 53 · Discontinued | $288.40 | $323.59 | $323.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,202.26 Typical High $1,202.26 | Professional | 54 · Surgery only | $1,071.52 | $1,202.26 | $1,202.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $239.88 Typical High $239.88 | Professional | 55 · Aftercare only | $213.80 | $239.88 | $239.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $162.18 Typical High $162.18 | Professional | 56 · Pre-op care only | $141.25 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,122.02 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,122.02 | $1,122.02 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $776.25 Median $794.33 Typical High $794.33 | Professional | 52 · Reduced service | $776.25 | $794.33 | $794.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $323.59 Typical High $323.59 | Professional | 53 · Discontinued | $309.03 | $323.59 | $323.59 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,202.26 Typical High $1,202.26 | Professional | 54 · Surgery only | $1,174.90 | $1,202.26 | $1,202.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $239.88 Typical High $239.88 | Professional | 55 · Aftercare only | $234.42 | $239.88 | $239.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $162.18 Typical High $162.18 | Professional | 56 · Pre-op care only | $154.88 | $162.18 | $162.18 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,122.02 Typical High $1,122.02 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,122.02 | $1,122.02 |
Where Maine sits
The same service costs 7.2 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
$1,698
AK $5,495TX $759
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.