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 $707.95 Median $707.95 Typical High $812.83 | Professional | None | $707.95 | $707.95 | $812.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $645.65 Median $1,023.29 Typical High $1,348.96 | Professional | None | $645.65 | $1,023.29 | $1,348.96 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $407.38 Median $645.65 Typical High $851.14 | Professional | 62 · Two surgeons | $407.38 | $645.65 | $851.14 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $104.71 Median $162.18 Typical High $218.78 | Professional | 80 · Assistant surgeon | $104.71 | $162.18 | $218.78 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $91.20 Median $141.25 Typical High $190.55 | Professional | AS · PA/NP assist | $91.20 | $141.25 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $3,019.95 Typical High $4,897.79 | Facility | None | $812.83 | $3,019.95 | $4,897.79 |
Cigna Setting Professional Modifier None Typical Low $933.25 Median $977.24 Typical High $1,584.89 | Professional | None | $933.25 | $977.24 | $1,584.89 |
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 $794.33 Median $1,047.13 Typical High $1,318.26 | Professional | None | $794.33 | $1,047.13 | $1,318.26 |
Martin's Point Setting Professional Modifier None Typical Low $707.95 Median $707.95 Typical High $812.83 | Professional | None | $707.95 | $707.95 | $812.83 |
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 $776.25 Median $1,122.02 Typical High $1,412.54 | Professional | None | $776.25 | $1,122.02 | $1,412.54 |
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 $354.81 Median $354.81 Typical High $354.81 | Professional | 52 · Reduced service | $354.81 | $354.81 | $354.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | 53 · Discontinued | $141.25 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $537.03 Median $537.03 Typical High $537.03 | Professional | 54 · Surgery only | $537.03 | $537.03 | $537.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $107.15 Median $107.15 Typical High $107.15 | Professional | 55 · Aftercare only | $107.15 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $70.79 Median $70.79 Typical High $70.79 | Professional | 56 · Pre-op care only | $70.79 | $70.79 | $70.79 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $501.19 Median $501.19 Typical High $501.19 | Professional | 78 · Unplanned return to OR | $501.19 | $501.19 | $501.19 |
Where Maine sits
The same service costs 8.7 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· 31st of 51
$1,023
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.