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 $616.60 Median $616.60 Typical High $616.60 | Professional | None | $616.60 | $616.60 | $616.60 |
Anthem BCBS Setting Professional Modifier None Typical Low $549.54 Median $870.96 Typical High $1,202.26 | Professional | None | $549.54 | $870.96 | $1,202.26 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $346.74 Median $537.03 Typical High $741.31 | Professional | 62 · Two surgeons | $346.74 | $537.03 | $741.31 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $89.13 Median $138.04 Typical High $190.55 | Professional | 80 · Assistant surgeon | $89.13 | $138.04 | $190.55 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $77.62 Median $120.23 Typical High $165.96 | Professional | AS · PA/NP assist | $77.62 | $120.23 | $165.96 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $2,570.40 Typical High $4,168.69 | Facility | None | $707.95 | $2,570.40 | $4,168.69 |
Cigna Setting Professional Modifier None Typical Low $758.58 Median $851.14 Typical High $1,380.38 | Professional | None | $758.58 | $851.14 | $1,380.38 |
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 $676.08 Median $870.96 Typical High $1,122.02 | Professional | None | $676.08 | $870.96 | $1,122.02 |
Martin's Point Setting Professional Modifier None Typical Low $616.60 Median $616.60 Typical High $616.60 | Professional | None | $616.60 | $616.60 | $616.60 |
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 $645.65 Median $912.01 Typical High $1,230.27 | Professional | None | $645.65 | $912.01 | $1,230.27 |
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 $309.03 Median $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $309.03 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | 53 · Discontinued | $123.03 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $467.74 Median $467.74 Typical High $467.74 | Professional | 54 · Surgery only | $467.74 | $467.74 | $467.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $93.33 Median $93.33 Typical High $93.33 | Professional | 55 · Aftercare only | $93.33 | $93.33 | $93.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $61.66 Median $61.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $61.66 | $61.66 | $61.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $436.52 Median $436.52 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $436.52 | $436.52 | $436.52 |
Where Maine sits
The same service costs 6.2 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· 30th of 51
$851
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.