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 $5,623.41 Median $5,623.41 Typical High $5,623.41 | Professional | None | $5,623.41 | $5,623.41 | $5,623.41 |
Anthem BCBS Setting Professional Modifier None Typical Low $4,265.80 Median $6,456.54 Typical High $8,511.38 | Professional | None | $4,265.80 | $6,456.54 | $8,511.38 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,691.53 Median $4,073.80 Typical High $5,370.32 | Professional | 62 · Two surgeons | $2,691.53 | $4,073.80 | $5,370.32 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $676.08 Median $1,023.29 Typical High $1,380.38 | Professional | 80 · Assistant surgeon | $676.08 | $1,023.29 | $1,380.38 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $588.84 Median $891.25 Typical High $1,202.26 | Professional | AS · PA/NP assist | $588.84 | $891.25 | $1,202.26 |
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 $4,677.35 Median $6,606.93 Typical High $8,709.64 | Professional | None | $4,677.35 | $6,606.93 | $8,709.64 |
Martin's Point Setting Professional Modifier None Typical Low $5,623.41 Median $5,623.41 Typical High $5,623.41 | Professional | None | $5,623.41 | $5,623.41 | $5,623.41 |
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 $4,570.88 Median $7,079.46 Typical High $8,709.64 | Professional | None | $4,570.88 | $7,079.46 | $8,709.64 |
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 $2,754.23 Median $2,754.23 Typical High $2,754.23 | Professional | 52 · Reduced service | $2,754.23 | $2,754.23 | $2,754.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1,122.02 Median $1,122.02 Typical High $1,122.02 | Professional | 53 · Discontinued | $1,122.02 | $1,122.02 | $1,122.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $4,168.69 Median $4,168.69 Typical High $4,168.69 | Professional | 54 · Surgery only | $4,168.69 | $4,168.69 | $4,168.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $831.76 Median $831.76 Typical High $831.76 | Professional | 55 · Aftercare only | $831.76 | $831.76 | $831.76 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $562.34 Median $562.34 Typical High $562.34 | Professional | 56 · Pre-op care only | $562.34 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,890.45 Median $3,890.45 Typical High $3,890.45 | Professional | 78 · Unplanned return to OR | $3,890.45 | $3,890.45 | $3,890.45 |
Where Maine sits
The same service costs 24.0 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· 16th of 51
$6,310
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.