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 $588.84 Median $588.84 Typical High $588.84 | Professional | None | $588.84 | $588.84 | $588.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $524.81 Median $812.83 Typical High $1,122.02 | Professional | None | $524.81 | $812.83 | $1,122.02 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $331.13 Median $512.86 Typical High $707.95 | Professional | 62 · Two surgeons | $331.13 | $512.86 | $707.95 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $83.18 Median $131.83 Typical High $181.97 | Professional | 80 · Assistant surgeon | $83.18 | $131.83 | $181.97 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $74.13 Median $114.82 Typical High $158.49 | Professional | AS · PA/NP assist | $74.13 | $114.82 | $158.49 |
Cigna Setting Facility Modifier None Typical Low $1,148.15 Median $3,090.30 Typical High $4,168.69 | Facility | None | $1,148.15 | $3,090.30 | $4,168.69 |
Cigna Setting Professional Modifier None Typical Low $724.44 Median $812.83 Typical High $1,318.26 | Professional | None | $724.44 | $812.83 | $1,318.26 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $645.65 Median $812.83 Typical High $1,071.52 | Professional | None | $645.65 | $812.83 | $1,071.52 |
Martin's Point Setting Professional Modifier None Typical Low $588.84 Median $588.84 Typical High $588.84 | Professional | None | $588.84 | $588.84 | $588.84 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
United Setting Professional Modifier None Typical Low $602.56 Median $870.96 Typical High $1,174.90 | Professional | None | $602.56 | $870.96 | $1,174.90 |
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 $295.12 Median $295.12 Typical High $295.12 | Professional | 52 · Reduced service | $295.12 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $117.49 Median $117.49 Typical High $117.49 | Professional | 53 · Discontinued | $117.49 | $117.49 | $117.49 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $446.68 Median $446.68 Typical High $446.68 | Professional | 54 · Surgery only | $446.68 | $446.68 | $446.68 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $89.13 Median $89.13 Typical High $89.13 | Professional | 55 · Aftercare only | $89.13 | $89.13 | $89.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $58.88 Median $58.88 Typical High $58.88 | Professional | 56 · Pre-op care only | $58.88 | $58.88 | $58.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $416.87 Median $416.87 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $416.87 | $416.87 | $416.87 |
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
$813
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.