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 $691.83 Median $741.31 Typical High $741.31 | Professional | None | $691.83 | $741.31 | $741.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $524.81 Median $831.76 Typical High $1,122.02 | Professional | None | $524.81 | $831.76 | $1,122.02 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $331.13 Median $524.81 Typical High $691.83 | Professional | 62 · Two surgeons | $331.13 | $524.81 | $691.83 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $85.11 Median $131.83 Typical High $177.83 | Professional | 80 · Assistant surgeon | $85.11 | $131.83 | $177.83 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $74.13 Median $117.49 Typical High $154.88 | Professional | AS · PA/NP assist | $74.13 | $117.49 | $154.88 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $2,570.40 Typical High $4,168.69 | Facility | None | $707.95 | $2,570.40 | $4,168.69 |
Cigna Setting Professional Modifier None Typical Low $758.58 Median $794.33 Typical High $1,318.26 | Professional | None | $758.58 | $794.33 | $1,318.26 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $660.69 Median $851.14 Typical High $1,071.52 | Professional | None | $660.69 | $851.14 | $1,071.52 |
Martin's Point Setting Professional Modifier None Typical Low $602.56 Median $741.31 Typical High $741.31 | Professional | None | $602.56 | $741.31 | $741.31 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
United Setting Professional Modifier None Typical Low $645.65 Median $912.01 Typical High $1,148.15 | Professional | None | $645.65 | $912.01 | $1,148.15 |
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 $371.54 Median $371.54 Typical High $371.54 | Professional | 52 · Reduced service | $371.54 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $147.91 Typical High $147.91 | Professional | 53 · Discontinued | $147.91 | $147.91 | $147.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $562.34 Median $562.34 Typical High $562.34 | Professional | 54 · Surgery only | $562.34 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | 55 · Aftercare only | $112.20 | $112.20 | $112.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | 56 · Pre-op care only | $74.13 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $524.81 Median $524.81 Typical High $524.81 | Professional | 78 · Unplanned return to OR | $524.81 | $524.81 | $524.81 |
Where Maine sits
The same service costs 9.8 times more in Oklahoma than in Utah. 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· 32nd of 51
$832
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.