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 $933.25 Median $933.25 Typical High $1,071.52 | Professional | None | $933.25 | $933.25 | $1,071.52 |
Anthem BCBS Setting Professional Modifier None Typical Low $851.14 Median $1,318.26 Typical High $1,778.28 | Professional | None | $851.14 | $1,318.26 | $1,778.28 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $537.03 Median $831.76 Typical High $1,122.02 | Professional | 62 · Two surgeons | $537.03 | $831.76 | $1,122.02 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $134.90 Median $213.80 Typical High $288.40 | Professional | 80 · Assistant surgeon | $134.90 | $213.80 | $288.40 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $120.23 Median $186.21 Typical High $251.19 | Professional | AS · PA/NP assist | $120.23 | $186.21 | $251.19 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $5,623.41 Typical High $8,912.51 | Facility | None | $812.83 | $5,623.41 | $8,912.51 |
Cigna Setting Professional Modifier None Typical Low $1,230.27 Median $1,288.25 Typical High $2,089.30 | Professional | None | $1,230.27 | $1,288.25 | $2,089.30 |
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 $1,047.13 Median $1,445.44 Typical High $1,862.09 | Professional | None | $1,047.13 | $1,445.44 | $1,862.09 |
Martin's Point Setting Professional Modifier None Typical Low $933.25 Median $933.25 Typical High $1,071.52 | Professional | None | $933.25 | $933.25 | $1,071.52 |
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 $1,047.13 Median $1,513.56 Typical High $1,862.09 | Professional | None | $1,047.13 | $1,513.56 | $1,862.09 |
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 52 · Reduced service Typical Low $467.74 Median $467.74 Typical High $467.74 | Professional | 52 · Reduced service | $467.74 | $467.74 | $467.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $190.55 Median $190.55 Typical High $190.55 | Professional | 53 · Discontinued | $190.55 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $707.95 Median $707.95 Typical High $707.95 | Professional | 54 · Surgery only | $707.95 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | 55 · Aftercare only | $141.25 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $93.33 Median $93.33 Typical High $93.33 | Professional | 56 · Pre-op care only | $93.33 | $93.33 | $93.33 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $660.69 Median $660.69 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $660.69 | $660.69 | $660.69 |
Where Maine sits
The same service costs 6.3 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· 29th of 51
$1,349
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.