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 $371.54 Median $371.54 Typical High $371.54 | Professional | None | $371.54 | $371.54 | $371.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $331.13 Median $524.81 Typical High $707.95 | Professional | None | $331.13 | $524.81 | $707.95 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $208.93 Median $331.13 Typical High $446.68 | Professional | 62 · Two surgeons | $208.93 | $331.13 | $446.68 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $53.70 Median $83.18 Typical High $114.82 | Professional | 80 · Assistant surgeon | $53.70 | $83.18 | $114.82 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $46.77 Median $72.44 Typical High $100.00 | Professional | AS · PA/NP assist | $46.77 | $72.44 | $100.00 |
Cigna Setting Facility Modifier None Typical Low $1,148.15 Median $2,344.23 Typical High $3,235.94 | Facility | None | $1,148.15 | $2,344.23 | $3,235.94 |
Cigna Setting Professional Modifier None Typical Low $467.74 Median $512.86 Typical High $831.76 | Professional | None | $467.74 | $512.86 | $831.76 |
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 $407.38 Median $524.81 Typical High $676.08 | Professional | None | $407.38 | $524.81 | $676.08 |
Martin's Point Setting Professional Modifier None Typical Low $371.54 Median $371.54 Typical High $371.54 | Professional | None | $371.54 | $371.54 | $371.54 |
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 $389.05 Median $562.34 Typical High $741.31 | Professional | None | $389.05 | $562.34 | $741.31 |
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 $186.21 Median $186.21 Typical High $186.21 | Professional | 52 · Reduced service | $186.21 | $186.21 | $186.21 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | 53 · Discontinued | $74.13 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | 54 · Surgery only | $281.84 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $56.23 Median $56.23 Typical High $56.23 | Professional | 55 · Aftercare only | $56.23 | $56.23 | $56.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $37.15 Median $37.15 Typical High $37.15 | Professional | 56 · Pre-op care only | $37.15 | $37.15 | $37.15 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $263.03 Median $263.03 Typical High $263.03 | Professional | 78 · Unplanned return to OR | $263.03 | $263.03 | $263.03 |
Where Maine sits
The same service costs 7.1 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· 31st of 51
$513
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.