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 $549.54 Median $549.54 Typical High $630.96 | Professional | None | $549.54 | $549.54 | $630.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $575.44 Median $676.08 Typical High $933.25 | Professional | None | $575.44 | $676.08 | $933.25 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $363.08 Median $426.58 Typical High $588.84 | Professional | 62 · Two surgeons | $363.08 | $426.58 | $588.84 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $91.20 Median $107.15 Typical High $147.91 | Professional | 80 · Assistant surgeon | $91.20 | $107.15 | $147.91 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $79.43 Median $95.50 Typical High $128.82 | Professional | AS · PA/NP assist | $79.43 | $95.50 | $128.82 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $2,344.23 Typical High $3,090.30 | Facility | None | $1,000.00 | $2,344.23 | $3,090.30 |
Cigna Setting Professional Modifier None Typical Low $724.44 Median $758.58 Typical High $1,230.27 | Professional | None | $724.44 | $758.58 | $1,230.27 |
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 $630.96 Median $977.24 Typical High $1,445.44 | Professional | None | $630.96 | $977.24 | $1,445.44 |
Martin's Point Setting Professional Modifier None Typical Low $549.54 Median $549.54 Typical High $616.60 | Professional | None | $549.54 | $549.54 | $616.60 |
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 $776.25 Median $1,148.15 Typical High $1,513.56 | Professional | None | $776.25 | $1,148.15 | $1,513.56 |
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 $275.42 Median $275.42 Typical High $275.42 | Professional | 52 · Reduced service | $275.42 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $109.65 Median $109.65 Typical High $109.65 | Professional | 53 · Discontinued | $109.65 | $109.65 | $109.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | 54 · Surgery only | $416.87 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | 55 · Aftercare only | $83.18 | $83.18 | $83.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $54.95 Median $54.95 Typical High $54.95 | Professional | 56 · Pre-op care only | $54.95 | $54.95 | $54.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $389.05 Median $389.05 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $389.05 | $389.05 | $389.05 |
Where Maine sits
The same service costs 7.4 times more in Oklahoma than in New York. 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· 50th of 51
$759
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.