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 $1,148.15 Median $1,148.15 Typical High $1,148.15 | Professional | None | $1,148.15 | $1,148.15 | $1,148.15 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,000.00 Median $1,584.89 Typical High $2,137.96 | Professional | None | $1,000.00 | $1,584.89 | $2,137.96 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $630.96 Median $1,000.00 Typical High $1,348.96 | Professional | 62 · Two surgeons | $630.96 | $1,000.00 | $1,348.96 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $158.49 Median $257.04 Typical High $338.84 | Professional | 80 · Assistant surgeon | $158.49 | $257.04 | $338.84 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $138.04 Median $223.87 Typical High $302.00 | Professional | AS · PA/NP assist | $138.04 | $223.87 | $302.00 |
Cigna Setting Facility Modifier None Typical Low $1,148.15 Median $5,754.40 Typical High $9,120.11 | Facility | None | $1,148.15 | $5,754.40 | $9,120.11 |
Cigna Setting Professional Modifier None Typical Low $1,380.38 Median $1,548.82 Typical High $2,454.71 | Professional | None | $1,380.38 | $1,548.82 | $2,454.71 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,230.27 Median $1,584.89 Typical High $2,041.74 | Professional | None | $1,230.27 | $1,584.89 | $2,041.74 |
Martin's Point Setting Professional Modifier None Typical Low $1,148.15 Median $1,148.15 Typical High $1,148.15 | Professional | None | $1,148.15 | $1,148.15 | $1,148.15 |
United Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
United Setting Professional Modifier None Typical Low $1,230.27 Median $1,737.80 Typical High $2,238.72 | Professional | None | $1,230.27 | $1,737.80 | $2,238.72 |
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 $575.44 Median $575.44 Typical High $575.44 | Professional | 52 · Reduced service | $575.44 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $229.09 Median $229.09 Typical High $229.09 | Professional | 53 · Discontinued | $229.09 | $229.09 | $229.09 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $851.14 Typical High $851.14 | Professional | 54 · Surgery only | $851.14 | $851.14 | $851.14 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $169.82 Median $169.82 Typical High $169.82 | Professional | 55 · Aftercare only | $169.82 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $114.82 Median $114.82 Typical High $114.82 | Professional | 56 · Pre-op care only | $114.82 | $114.82 | $114.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $794.33 Median $794.33 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $794.33 | $794.33 | $794.33 |
Where Maine sits
The same service costs 8.7 times more in Oklahoma than in Texas. 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
$1,585
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.