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 $269.15 Median $281.84 Typical High $316.23 | Professional | None | $269.15 | $281.84 | $316.23 |
Anthem BCBS Setting Professional Modifier None Typical Low $213.80 Median $251.19 Typical High $316.23 | Professional | None | $213.80 | $251.19 | $316.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $134.90 Median $158.49 Typical High $199.53 | Professional | 62 · Two surgeons | $134.90 | $158.49 | $199.53 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $34.67 Median $40.74 Typical High $50.12 | Professional | 80 · Assistant surgeon | $34.67 | $40.74 | $50.12 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $30.20 Median $35.48 Typical High $44.67 | Professional | AS · PA/NP assist | $30.20 | $35.48 | $44.67 |
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 $309.03 Median $346.74 Typical High $562.34 | Professional | None | $309.03 | $346.74 | $562.34 |
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 $213.80 Median $275.42 Typical High $398.11 | Professional | None | $213.80 | $275.42 | $398.11 |
Martin's Point Setting Professional Modifier None Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | None | $281.84 | $281.84 | $281.84 |
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 $213.80 Median $295.12 Typical High $457.09 | Professional | None | $213.80 | $295.12 | $457.09 |
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 $199.53 Median $213.80 Typical High $223.87 | Professional | 54 · Surgery only | $199.53 | $213.80 | $223.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $40.74 Median $42.66 Typical High $44.67 | Professional | 55 · Aftercare only | $40.74 | $42.66 | $44.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.92 Median $28.18 Typical High $29.51 | Professional | 56 · Pre-op care only | $26.92 | $28.18 | $29.51 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $213.80 Median $213.80 Typical High $213.80 | Professional | 54 · Surgery only | $213.80 | $213.80 | $213.80 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $42.66 Median $42.66 Typical High $42.66 | Professional | 55 · Aftercare only | $42.66 | $42.66 | $42.66 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $28.18 Typical High $28.18 | Professional | 56 · Pre-op care only | $28.18 | $28.18 | $28.18 |
Where Maine sits
The same service costs 8.1 times more in New York than in Missouri. 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· 37th of 51
$282
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.