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 $426.58 Median $426.58 Typical High $776.25 | Professional | None | $426.58 | $426.58 | $776.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $398.11 Median $616.60 Typical High $812.83 | Professional | None | $398.11 | $616.60 | $812.83 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $588.84 Median $912.01 Typical High $1,230.27 | Professional | 50 · Both sides | $588.84 | $912.01 | $1,230.27 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $251.19 Median $389.05 Typical High $512.86 | Professional | 62 · Two surgeons | $251.19 | $389.05 | $512.86 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $63.10 Median $97.72 Typical High $131.83 | Professional | 80 · Assistant surgeon | $63.10 | $97.72 | $131.83 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $54.95 Median $85.11 Typical High $114.82 | Professional | AS · PA/NP assist | $54.95 | $85.11 | $114.82 |
Cigna Setting Facility Modifier None Typical Low $2,137.96 Median $4,073.80 Typical High $5,754.40 | Facility | None | $2,137.96 | $4,073.80 | $5,754.40 |
Cigna Setting Professional Modifier None Typical Low $575.44 Median $588.84 Typical High $977.24 | Professional | None | $575.44 | $588.84 | $977.24 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $489.78 Median $630.96 Typical High $812.83 | Professional | None | $489.78 | $630.96 | $812.83 |
Martin's Point Setting Professional Modifier None Typical Low $426.58 Median $426.58 Typical High $776.25 | Professional | None | $426.58 | $426.58 | $776.25 |
United Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
United Setting Professional Modifier None Typical Low $436.52 Median $676.08 Typical High $870.96 | Professional | None | $436.52 | $676.08 | $870.96 |
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 $213.80 Median $213.80 Typical High $213.80 | Professional | 52 · Reduced service | $213.80 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $85.11 Median $85.11 Typical High $85.11 | Professional | 53 · Discontinued | $85.11 | $85.11 | $85.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $323.59 Median $323.59 Typical High $323.59 | Professional | 54 · Surgery only | $323.59 | $323.59 | $323.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $64.57 Median $64.57 Typical High $64.57 | Professional | 55 · Aftercare only | $64.57 | $64.57 | $64.57 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $42.66 Median $42.66 Typical High $42.66 | Professional | 56 · Pre-op care only | $42.66 | $42.66 | $42.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $302.00 | $302.00 | $302.00 |
Where Maine sits
The same service costs 9.5 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· 33rd of 51
$603
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.