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 $3,715.35 Median $5,888.44 Typical High $5,888.44 | Professional | None | $3,715.35 | $5,888.44 | $5,888.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $4,466.84 Median $6,760.83 Typical High $9,120.11 | Professional | None | $4,466.84 | $6,760.83 | $9,120.11 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,818.38 Median $4,265.80 Typical High $5,754.40 | Professional | 62 · Two surgeons | $2,818.38 | $4,265.80 | $5,754.40 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $724.44 Median $1,096.48 Typical High $1,445.44 | Professional | 80 · Assistant surgeon | $724.44 | $1,096.48 | $1,445.44 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $630.96 Median $954.99 Typical High $1,258.93 | Professional | AS · PA/NP assist | $630.96 | $954.99 | $1,258.93 |
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 $4,897.79 Median $7,079.46 Typical High $9,120.11 | Professional | None | $4,897.79 | $7,079.46 | $9,120.11 |
Martin's Point Setting Professional Modifier None Typical Low $4,786.30 Median $5,888.44 Typical High $5,888.44 | Professional | None | $4,786.30 | $5,888.44 | $5,888.44 |
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 $4,786.30 Median $7,585.78 Typical High $9,120.11 | Professional | None | $4,786.30 | $7,585.78 | $9,120.11 |
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 $2,951.21 Median $2,951.21 Typical High $2,951.21 | Professional | 52 · Reduced service | $2,951.21 | $2,951.21 | $2,951.21 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1,174.90 Median $1,174.90 Typical High $1,174.90 | Professional | 53 · Discontinued | $1,174.90 | $1,174.90 | $1,174.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $4,466.84 Median $4,466.84 Typical High $4,466.84 | Professional | 54 · Surgery only | $4,466.84 | $4,466.84 | $4,466.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $891.25 Median $891.25 Typical High $891.25 | Professional | 55 · Aftercare only | $891.25 | $891.25 | $891.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $588.84 Median $588.84 Typical High $588.84 | Professional | 56 · Pre-op care only | $588.84 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $4,168.69 Median $4,168.69 Typical High $4,168.69 | Professional | 78 · Unplanned return to OR | $4,168.69 | $4,168.69 | $4,168.69 |
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· 17th of 51
$6,607
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.