How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $389.05 Median $457.09 Typical High $457.09 | Professional | None | $389.05 | $457.09 | $457.09 |
Anthem BCBS Setting Facility Modifier None Typical Low $12,589.25 Median $16,218.10 Typical High $16,982.44 | Facility | None | $12,589.25 | $16,218.10 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $371.54 Median $512.86 Typical High $776.25 | Professional | None | $371.54 | $512.86 | $776.25 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $234.42 Median $302.00 Typical High $457.09 | Professional | 62 · Two surgeons | $234.42 | $302.00 | $457.09 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $58.88 Median $77.62 Typical High $114.82 | Professional | 80 · Assistant surgeon | $58.88 | $77.62 | $114.82 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $51.29 Median $67.61 Typical High $100.00 | Professional | AS · PA/NP assist | $51.29 | $67.61 | $100.00 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $707.95 Typical High $2,290.87 | Facility | None | $151.36 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $489.78 Median $549.54 Typical High $812.83 | Professional | None | $489.78 | $549.54 | $812.83 |
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 $380.19 Median $501.19 Typical High $707.95 | Professional | None | $380.19 | $501.19 | $707.95 |
Martin's Point Setting Professional Modifier None Typical Low $436.52 Median $457.09 Typical High $457.09 | Professional | None | $436.52 | $457.09 | $457.09 |
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 $371.54 Median $537.03 Typical High $724.44 | Professional | None | $371.54 | $537.03 | $724.44 |
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 54 · Surgery only Typical Low $295.12 Median $346.74 Typical High $346.74 | Professional | 54 · Surgery only | $295.12 | $346.74 | $346.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $58.88 Median $69.18 Typical High $69.18 | Professional | 55 · Aftercare only | $58.88 | $69.18 | $69.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $38.90 Median $45.71 Typical High $45.71 | Professional | 56 · Pre-op care only | $38.90 | $45.71 | $45.71 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $331.13 Median $346.74 Typical High $346.74 | Professional | 54 · Surgery only | $331.13 | $346.74 | $346.74 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $69.18 Typical High $69.18 | Professional | 55 · Aftercare only | $66.07 | $69.18 | $69.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $45.71 Typical High $45.71 | Professional | 56 · Pre-op care only | $43.65 | $45.71 | $45.71 |
Where Maine sits
The same service costs 4.4 times more in Alaska than in New Jersey. 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· 24th of 51
$525
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.