How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $1,071.52 Median $1,122.02 Typical High $1,122.02 | Professional | None | $1,071.52 | $1,122.02 | $1,122.02 |
Anthem BCBS Setting Facility Modifier None Typical Low $11,748.98 Median $14,791.08 Typical High $15,488.17 | Facility | None | $11,748.98 | $14,791.08 | $15,488.17 |
Anthem BCBS Setting Professional Modifier None Typical Low $977.24 Median $1,445.44 Typical High $1,905.46 | Professional | None | $977.24 | $1,445.44 | $1,905.46 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $158.49 Median $229.09 Typical High $309.03 | Professional | 80 · Assistant surgeon | $158.49 | $229.09 | $309.03 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $138.04 Median $199.53 Typical High $269.15 | Professional | AS · PA/NP assist | $138.04 | $199.53 | $269.15 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $707.95 Typical High $2,290.87 | Facility | None | $151.36 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,202.26 Median $1,258.93 Typical High $2,187.76 | Professional | None | $1,202.26 | $1,258.93 | $2,187.76 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,096.48 Median $1,479.11 Typical High $1,905.46 | Professional | None | $1,096.48 | $1,479.11 | $1,905.46 |
Martin's Point Setting Professional Modifier None Typical Low $1,071.52 Median $1,122.02 Typical High $1,122.02 | Professional | None | $1,071.52 | $1,122.02 | $1,122.02 |
United Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $977.24 Median $1,479.11 Typical High $1,949.84 | Professional | None | $977.24 | $1,479.11 | $1,949.84 |
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 $562.34 Median $562.34 Typical High $562.34 | Professional | 52 · Reduced service | $562.34 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $223.87 Typical High $223.87 | Professional | 53 · Discontinued | $223.87 | $223.87 | $223.87 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $831.76 Typical High $831.76 | Professional | 54 · Surgery only | $831.76 | $831.76 | $831.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $165.96 Typical High $165.96 | Professional | 55 · Aftercare only | $165.96 | $165.96 | $165.96 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | 56 · Pre-op care only | $112.20 | $112.20 | $112.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $776.25 Typical High $776.25 | Professional | 78 · Unplanned return to OR | $776.25 | $776.25 | $776.25 |
Where Maine sits
The same service costs 6.8 times more in Alaska 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· 18th of 51
$1,445
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.