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 $812.83 Median $812.83 Typical High $933.25 | Professional | None | $812.83 | $812.83 | $933.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $741.31 Median $1,148.15 Typical High $1,548.82 | Professional | None | $741.31 | $1,148.15 | $1,548.82 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $467.74 Median $724.44 Typical High $977.24 | Professional | 62 · Two surgeons | $467.74 | $724.44 | $977.24 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $117.49 Median $186.21 Typical High $251.19 | Professional | 80 · Assistant surgeon | $117.49 | $186.21 | $251.19 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $104.71 Median $162.18 Typical High $218.78 | Professional | AS · PA/NP assist | $104.71 | $162.18 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $2,290.87 Typical High $3,090.30 | Facility | None | $812.83 | $2,290.87 | $3,090.30 |
Cigna Setting Professional Modifier None Typical Low $1,071.52 Median $1,122.02 Typical High $1,819.70 | Professional | None | $1,071.52 | $1,122.02 | $1,819.70 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $912.01 Median $1,202.26 Typical High $1,548.82 | Professional | None | $912.01 | $1,202.26 | $1,548.82 |
Martin's Point Setting Professional Modifier None Typical Low $812.83 Median $812.83 Typical High $933.25 | Professional | None | $812.83 | $812.83 | $933.25 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
United Setting Professional Modifier None Typical Low $912.01 Median $1,288.25 Typical High $1,621.81 | Professional | None | $912.01 | $1,288.25 | $1,621.81 |
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 $407.38 Median $407.38 Typical High $407.38 | Professional | 52 · Reduced service | $407.38 | $407.38 | $407.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | 53 · Discontinued | $162.18 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $616.60 Median $616.60 Typical High $616.60 | Professional | 54 · Surgery only | $616.60 | $616.60 | $616.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | 55 · Aftercare only | $123.03 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $81.28 Typical High $81.28 | Professional | 56 · Pre-op care only | $81.28 | $81.28 | $81.28 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $575.44 Median $575.44 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $575.44 | $575.44 | $575.44 |
Where Maine sits
The same service costs 6.6 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· 30th of 51
$1,175
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.