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 $691.83 Median $691.83 Typical High $691.83 | Professional | None | $691.83 | $691.83 | $691.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $616.60 Median $977.24 Typical High $1,318.26 | Professional | None | $616.60 | $977.24 | $1,318.26 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $933.25 Median $1,445.44 Typical High $1,949.84 | Professional | 50 · Both sides | $933.25 | $1,445.44 | $1,949.84 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $389.05 Median $616.60 Typical High $831.76 | Professional | 62 · Two surgeons | $389.05 | $616.60 | $831.76 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $100.00 Median $154.88 Typical High $208.93 | Professional | 80 · Assistant surgeon | $100.00 | $154.88 | $208.93 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $87.10 Median $134.90 Typical High $181.97 | Professional | AS · PA/NP assist | $87.10 | $134.90 | $181.97 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,348.96 Typical High $2,290.87 | Facility | None | $707.95 | $1,348.96 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $891.25 Median $933.25 Typical High $1,548.82 | Professional | None | $891.25 | $933.25 | $1,548.82 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $776.25 Median $1,000.00 Typical High $1,258.93 | Professional | None | $776.25 | $1,000.00 | $1,258.93 |
Martin's Point Setting Professional Modifier None Typical Low $691.83 Median $691.83 Typical High $691.83 | Professional | None | $691.83 | $691.83 | $691.83 |
United Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
United Setting Professional Modifier None Typical Low $724.44 Median $1,071.52 Typical High $1,380.38 | Professional | None | $724.44 | $1,071.52 | $1,380.38 |
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 $346.74 Median $346.74 Typical High $346.74 | Professional | 52 · Reduced service | $346.74 | $346.74 | $346.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $138.04 Median $138.04 Typical High $138.04 | Professional | 53 · Discontinued | $138.04 | $138.04 | $138.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $512.86 Median $512.86 Typical High $512.86 | Professional | 54 · Surgery only | $512.86 | $512.86 | $512.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $102.33 Median $102.33 Typical High $102.33 | Professional | 55 · Aftercare only | $102.33 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $69.18 Median $69.18 Typical High $69.18 | Professional | 56 · Pre-op care only | $69.18 | $69.18 | $69.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $478.63 Median $478.63 Typical High $478.63 | Professional | 78 · Unplanned return to OR | $478.63 | $478.63 | $478.63 |
Where Maine sits
The same service costs 6.0 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· 28th of 51
$977
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.