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 $2,818.38 Median $3,090.30 Typical High $4,365.16 | Professional | None | $2,818.38 | $3,090.30 | $4,365.16 |
Anthem BCBS Setting Professional Modifier None Typical Low $2,290.87 Median $3,467.37 Typical High $4,677.35 | Professional | None | $2,290.87 | $3,467.37 | $4,677.35 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,445.44 Median $2,187.76 Typical High $2,951.21 | Professional | 62 · Two surgeons | $1,445.44 | $2,187.76 | $2,951.21 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $363.08 Median $562.34 Typical High $741.31 | Professional | 80 · Assistant surgeon | $363.08 | $562.34 | $741.31 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $323.59 Median $489.78 Typical High $645.65 | Professional | AS · PA/NP assist | $323.59 | $489.78 | $645.65 |
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 $2,691.53 Median $3,467.37 Typical High $4,677.35 | Professional | None | $2,691.53 | $3,467.37 | $4,677.35 |
Martin's Point Setting Professional Modifier None Typical Low $2,818.38 Median $3,090.30 Typical High $4,365.16 | Professional | None | $2,818.38 | $3,090.30 | $4,365.16 |
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 $2,454.71 Median $3,715.35 Typical High $4,786.30 | Professional | None | $2,454.71 | $3,715.35 | $4,786.30 |
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 $1,513.56 Median $1,513.56 Typical High $1,513.56 | Professional | 52 · Reduced service | $1,513.56 | $1,513.56 | $1,513.56 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $616.60 Median $616.60 Typical High $616.60 | Professional | 53 · Discontinued | $616.60 | $616.60 | $616.60 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,290.87 Median $2,290.87 Typical High $2,290.87 | Professional | 54 · Surgery only | $2,290.87 | $2,290.87 | $2,290.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $457.09 Median $457.09 Typical High $457.09 | Professional | 55 · Aftercare only | $457.09 | $457.09 | $457.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $309.03 Median $309.03 Typical High $309.03 | Professional | 56 · Pre-op care only | $309.03 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,137.96 Median $2,137.96 Typical High $2,137.96 | Professional | 78 · Unplanned return to OR | $2,137.96 | $2,137.96 | $2,137.96 |
Where Maine sits
The same service costs 5.8 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· 19th of 51
$3,311
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.