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 $407.38 Median $416.87 Typical High $660.69 | Professional | None | $407.38 | $416.87 | $660.69 |
Anthem BCBS Setting Professional Modifier None Typical Low $371.54 Median $436.52 Typical High $549.54 | Professional | None | $371.54 | $436.52 | $549.54 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $234.42 Median $275.42 Typical High $346.74 | Professional | 62 · Two surgeons | $234.42 | $275.42 | $346.74 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $60.26 Median $70.79 Typical High $87.10 | Professional | 80 · Assistant surgeon | $60.26 | $70.79 | $87.10 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $52.48 Median $61.66 Typical High $77.62 | Professional | AS · PA/NP assist | $52.48 | $61.66 | $77.62 |
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 $478.63 Median $537.03 Typical High $831.76 | Professional | None | $478.63 | $537.03 | $831.76 |
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 $316.23 Median $407.38 Typical High $588.84 | Professional | None | $316.23 | $407.38 | $588.84 |
Martin's Point Setting Professional Modifier None Typical Low $416.87 Median $416.87 Typical High $426.58 | Professional | None | $416.87 | $416.87 | $426.58 |
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 $316.23 Median $457.09 Typical High $660.69 | Professional | None | $316.23 | $457.09 | $660.69 |
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 $302.00 Median $316.23 Typical High $331.13 | Professional | 54 · Surgery only | $302.00 | $316.23 | $331.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $63.10 Typical High $66.07 | Professional | 55 · Aftercare only | $60.26 | $63.10 | $66.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $41.69 Typical High $44.67 | Professional | 56 · Pre-op care only | $40.74 | $41.69 | $44.67 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $316.23 Median $316.23 Typical High $316.23 | Professional | 54 · Surgery only | $316.23 | $316.23 | $316.23 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $63.10 Median $63.10 Typical High $63.10 | Professional | 55 · Aftercare only | $63.10 | $63.10 | $63.10 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $41.69 Typical High $41.69 | Professional | 56 · Pre-op care only | $41.69 | $41.69 | $41.69 |
Where Maine sits
The same service costs 15.1 times more in New York than in Hawaii. 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· 33rd of 51
$437
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.