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 $316.23 Median $316.23 Typical High $416.87 | Professional | None | $316.23 | $316.23 | $416.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $275.42 Median $446.68 Typical High $588.84 | Professional | None | $275.42 | $446.68 | $588.84 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $173.78 Median $281.84 Typical High $371.54 | Professional | 62 · Two surgeons | $173.78 | $281.84 | $371.54 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $43.65 Median $70.79 Typical High $95.50 | Professional | 80 · Assistant surgeon | $43.65 | $70.79 | $95.50 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $38.90 Median $61.66 Typical High $83.18 | Professional | AS · PA/NP assist | $38.90 | $61.66 | $83.18 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $2,570.40 Typical High $4,168.69 | Facility | None | $812.83 | $2,570.40 | $4,168.69 |
Cigna Setting Professional Modifier None Typical Low $398.11 Median $426.58 Typical High $691.83 | Professional | None | $398.11 | $426.58 | $691.83 |
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 $338.84 Median $524.81 Typical High $645.65 | Professional | None | $338.84 | $524.81 | $645.65 |
Martin's Point Setting Professional Modifier None Typical Low $316.23 Median $316.23 Typical High $416.87 | Professional | None | $316.23 | $316.23 | $416.87 |
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 $426.58 Median $537.03 Typical High $645.65 | Professional | None | $426.58 | $537.03 | $645.65 |
5 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 $158.49 Median $158.49 Typical High $158.49 | Professional | 52 · Reduced service | $158.49 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $64.57 Median $64.57 Typical High $64.57 | Professional | 53 · Discontinued | $64.57 | $64.57 | $64.57 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $239.88 Median $239.88 Typical High $239.88 | Professional | 54 · Surgery only | $239.88 | $239.88 | $239.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $47.86 Median $47.86 Typical High $47.86 | Professional | 55 · Aftercare only | $47.86 | $47.86 | $47.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $31.62 Median $31.62 Typical High $31.62 | Professional | 56 · Pre-op care only | $31.62 | $31.62 | $31.62 |
Where Maine sits
The same service costs 10.0 times more in Oklahoma than in New York. 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· 41st of 51
$447
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.