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 $288.40 Median $288.40 Typical High $288.40 | Professional | None | $288.40 | $288.40 | $288.40 |
Anthem BCBS Setting Professional Modifier None Typical Low $257.04 Median $398.11 Typical High $549.54 | Professional | None | $257.04 | $398.11 | $549.54 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $380.19 Median $602.56 Typical High $831.76 | Professional | 50 · Both sides | $380.19 | $602.56 | $831.76 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $162.18 Median $251.19 Typical High $346.74 | Professional | 62 · Two surgeons | $162.18 | $251.19 | $346.74 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $40.74 Median $64.57 Typical High $89.13 | Professional | 80 · Assistant surgeon | $40.74 | $64.57 | $89.13 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $35.48 Median $56.23 Typical High $77.62 | Professional | AS · PA/NP assist | $35.48 | $56.23 | $77.62 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $2,290.87 Typical High $3,090.30 | Facility | None | $707.95 | $2,290.87 | $3,090.30 |
Cigna Setting Professional Modifier None Typical Low $363.08 Median $398.11 Typical High $645.65 | Professional | None | $363.08 | $398.11 | $645.65 |
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 $316.23 Median $389.05 Typical High $524.81 | Professional | None | $316.23 | $389.05 | $524.81 |
Martin's Point Setting Professional Modifier None Typical Low $288.40 Median $288.40 Typical High $288.40 | Professional | None | $288.40 | $288.40 | $288.40 |
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 $316.23 Median $416.87 Typical High $575.44 | Professional | None | $316.23 | $416.87 | $575.44 |
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 $144.54 Median $144.54 Typical High $144.54 | Professional | 52 · Reduced service | $144.54 | $144.54 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $57.54 Median $57.54 Typical High $57.54 | Professional | 53 · Discontinued | $57.54 | $57.54 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $218.78 Median $218.78 Typical High $218.78 | Professional | 54 · Surgery only | $218.78 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $43.65 Median $43.65 Typical High $43.65 | Professional | 55 · Aftercare only | $43.65 | $43.65 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.84 Median $28.84 Typical High $28.84 | Professional | 56 · Pre-op care only | $28.84 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | 78 · Unplanned return to OR | $204.17 | $204.17 | $204.17 |
Where Maine sits
The same service costs 6.0 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
$398
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.