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 $489.78 Median $489.78 Typical High $549.54 | Professional | None | $489.78 | $489.78 | $549.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $446.68 Median $691.83 Typical High $933.25 | Professional | None | $446.68 | $691.83 | $933.25 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $676.08 Median $1,047.13 Typical High $1,412.54 | Professional | 50 · Both sides | $676.08 | $1,047.13 | $1,412.54 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $72.44 Median $112.20 Typical High $151.36 | Professional | 80 · Assistant surgeon | $72.44 | $112.20 | $151.36 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $63.10 Median $97.72 Typical High $131.83 | Professional | AS · PA/NP assist | $63.10 | $97.72 | $131.83 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $2,344.23 Typical High $3,162.28 | Facility | None | $1,000.00 | $2,344.23 | $3,162.28 |
Cigna Setting Professional Modifier None Typical Low $645.65 Median $676.08 Typical High $1,096.48 | Professional | None | $645.65 | $676.08 | $1,096.48 |
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 $562.34 Median $724.44 Typical High $912.01 | Professional | None | $562.34 | $724.44 | $912.01 |
Martin's Point Setting Professional Modifier None Typical Low $489.78 Median $489.78 Typical High $549.54 | Professional | None | $489.78 | $489.78 | $549.54 |
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 $512.86 Median $776.25 Typical High $977.24 | Professional | None | $512.86 | $776.25 | $977.24 |
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 $245.47 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $245.47 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $97.72 Median $97.72 Typical High $97.72 | Professional | 53 · Discontinued | $97.72 | $97.72 | $97.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $371.54 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $371.54 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $74.13 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $48.98 Median $48.98 Typical High $48.98 | Professional | 56 · Pre-op care only | $48.98 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $346.74 Median $346.74 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $346.74 | $346.74 | $346.74 |
Where Maine sits
The same service costs 10.0 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
$692
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.