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 $4,365.16 Median $4,365.16 Typical High $4,365.16 | Professional | None | $4,365.16 | $4,365.16 | $4,365.16 |
Anthem BCBS Setting Professional Modifier None Typical Low $3,311.31 Median $4,897.79 Typical High $6,606.93 | Professional | None | $3,311.31 | $4,897.79 | $6,606.93 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,089.30 Median $3,090.30 Typical High $4,168.69 | Professional | 62 · Two surgeons | $2,089.30 | $3,090.30 | $4,168.69 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $537.03 Median $794.33 Typical High $1,047.13 | Professional | 80 · Assistant surgeon | $537.03 | $794.33 | $1,047.13 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $467.74 Median $691.83 Typical High $933.25 | Professional | AS · PA/NP assist | $467.74 | $691.83 | $933.25 |
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 $3,630.78 Median $5,248.07 Typical High $6,760.83 | Professional | None | $3,630.78 | $5,248.07 | $6,760.83 |
Martin's Point Setting Professional Modifier None Typical Low $4,365.16 Median $4,365.16 Typical High $4,365.16 | Professional | None | $4,365.16 | $4,365.16 | $4,365.16 |
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 $3,548.13 Median $5,495.41 Typical High $6,760.83 | Professional | None | $3,548.13 | $5,495.41 | $6,760.83 |
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 $2,137.96 Median $2,137.96 Typical High $2,137.96 | Professional | 52 · Reduced service | $2,137.96 | $2,137.96 | $2,137.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $870.96 Median $870.96 Typical High $870.96 | Professional | 53 · Discontinued | $870.96 | $870.96 | $870.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3,235.94 Median $3,235.94 Typical High $3,235.94 | Professional | 54 · Surgery only | $3,235.94 | $3,235.94 | $3,235.94 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $645.65 Median $645.65 Typical High $645.65 | Professional | 55 · Aftercare only | $645.65 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $436.52 Median $436.52 Typical High $436.52 | Professional | 56 · Pre-op care only | $436.52 | $436.52 | $436.52 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,019.95 Median $3,019.95 Typical High $3,019.95 | Professional | 78 · Unplanned return to OR | $3,019.95 | $3,019.95 | $3,019.95 |
Where Maine sits
The same service costs 23.4 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· 15th of 51
$4,898
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.