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 $416.87 Median $416.87 Typical High $416.87 | Professional | None | $416.87 | $416.87 | $416.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $389.05 Median $602.56 Typical High $812.83 | Professional | None | $389.05 | $602.56 | $812.83 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $588.84 Median $912.01 Typical High $1,202.26 | Professional | 50 · Both sides | $588.84 | $912.01 | $1,202.26 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $61.66 Median $95.50 Typical High $128.82 | Professional | 80 · Assistant surgeon | $61.66 | $95.50 | $128.82 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $54.95 Median $85.11 Typical High $112.20 | Professional | AS · PA/NP assist | $54.95 | $85.11 | $112.20 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,348.96 Typical High $1,819.70 | Facility | None | $537.03 | $1,348.96 | $1,819.70 |
Cigna Setting Professional Modifier None Typical Low $575.44 Median $575.44 Typical High $954.99 | Professional | None | $575.44 | $575.44 | $954.99 |
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 $478.63 Median $616.60 Typical High $794.33 | Professional | None | $478.63 | $616.60 | $794.33 |
Martin's Point Setting Professional Modifier None Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | None | $416.87 | $416.87 | $416.87 |
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 $426.58 Median $660.69 Typical High $851.14 | Professional | None | $426.58 | $660.69 | $851.14 |
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 $208.93 Median $208.93 Typical High $208.93 | Professional | 52 · Reduced service | $208.93 | $208.93 | $208.93 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | 53 · Discontinued | $83.18 | $83.18 | $83.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $316.23 Median $316.23 Typical High $316.23 | Professional | 54 · Surgery only | $316.23 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $63.10 Median $63.10 Typical High $63.10 | Professional | 55 · Aftercare only | $63.10 | $63.10 | $63.10 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $41.69 Median $41.69 Typical High $41.69 | Professional | 56 · Pre-op care only | $41.69 | $41.69 | $41.69 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $295.12 Median $295.12 Typical High $295.12 | Professional | 78 · Unplanned return to OR | $295.12 | $295.12 | $295.12 |
Where Maine sits
The same service costs 5.1 times more in Alaska 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· 31st 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.