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 $346.74 Median $346.74 Typical High $346.74 | Professional | None | $346.74 | $346.74 | $346.74 |
Anthem BCBS Setting Professional Modifier None Typical Low $323.59 Median $501.19 Typical High $660.69 | Professional | None | $323.59 | $501.19 | $660.69 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $478.63 Median $741.31 Typical High $1,000.00 | Professional | 50 · Both sides | $478.63 | $741.31 | $1,000.00 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $51.29 Median $79.43 Typical High $107.15 | Professional | 80 · Assistant surgeon | $51.29 | $79.43 | $107.15 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $44.67 Median $69.18 Typical High $93.33 | Professional | AS · PA/NP assist | $44.67 | $69.18 | $93.33 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,905.46 Typical High $3,090.30 | Facility | None | $537.03 | $1,905.46 | $3,090.30 |
Cigna Setting Professional Modifier None Typical Low $467.74 Median $478.63 Typical High $776.25 | Professional | None | $467.74 | $478.63 | $776.25 |
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 $398.11 Median $512.86 Typical High $660.69 | Professional | None | $398.11 | $512.86 | $660.69 |
Martin's Point Setting Professional Modifier None Typical Low $346.74 Median $346.74 Typical High $346.74 | Professional | None | $346.74 | $346.74 | $346.74 |
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 $354.81 Median $549.54 Typical High $691.83 | Professional | None | $354.81 | $549.54 | $691.83 |
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 $173.78 Median $173.78 Typical High $173.78 | Professional | 52 · Reduced service | $173.78 | $173.78 | $173.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $69.18 Typical High $69.18 | Professional | 53 · Discontinued | $69.18 | $69.18 | $69.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $257.04 Median $257.04 Typical High $257.04 | Professional | 54 · Surgery only | $257.04 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $52.48 Median $52.48 Typical High $52.48 | Professional | 55 · Aftercare only | $52.48 | $52.48 | $52.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $34.67 Typical High $34.67 | Professional | 56 · Pre-op care only | $34.67 | $34.67 | $34.67 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | 78 · Unplanned return to OR | $239.88 | $239.88 | $239.88 |
Where Maine sits
The same service costs 6.9 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
$501
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.