How much rates vary
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 $288.40 Median $549.54 Typical High $741.31 | Professional | None | $288.40 | $549.54 | $741.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $380.19 Median $630.96 Typical High $851.14 | Professional | None | $380.19 | $630.96 | $851.14 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $239.88 Median $398.11 Typical High $537.03 | Professional | 62 · Two surgeons | $239.88 | $398.11 | $537.03 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $60.26 Median $102.33 Typical High $134.90 | Professional | 80 · Assistant surgeon | $60.26 | $102.33 | $134.90 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $53.70 Median $89.13 Typical High $120.23 | Professional | AS · PA/NP assist | $53.70 | $89.13 | $120.23 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $3,388.44 Typical High $5,495.41 | Facility | None | $707.95 | $3,388.44 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $512.86 Median $575.44 Typical High $1,000.00 | Professional | None | $512.86 | $575.44 | $1,000.00 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $346.74 Median $467.74 Typical High $776.25 | Professional | None | $346.74 | $467.74 | $776.25 |
Martin's Point Setting Professional Modifier None Typical Low $416.87 Median $549.54 Typical High $741.31 | Professional | None | $416.87 | $549.54 | $741.31 |
United Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
United Setting Professional Modifier None Typical Low $338.84 Median $436.52 Typical High $891.25 | Professional | None | $338.84 | $436.52 | $891.25 |
5 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 $275.42 Median $275.42 Typical High $275.42 | Professional | 52 · Reduced service | $275.42 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | 53 · Discontinued | $109.65 | $109.65 | $109.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | 54 · Surgery only | $416.87 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | 55 · Aftercare only | $83.18 | $83.18 | $83.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $54.95 Median $54.95 Typical High $54.95 | Professional | 56 · Pre-op care only | $54.95 | $54.95 | $54.95 |
Where Maine sits
The same service costs 5.2 times more in Alaska than in Kentucky. 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
$550
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.