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 $645.65 Median $645.65 Typical High $691.83 | Professional | None | $645.65 | $645.65 | $691.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $676.08 Median $1,000.00 Typical High $1,479.11 | Professional | None | $676.08 | $1,000.00 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $107.15 Median $151.36 Typical High $229.09 | Professional | 80 · Assistant surgeon | $107.15 | $151.36 | $229.09 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $95.50 Median $128.82 Typical High $204.17 | Professional | AS · PA/NP assist | $95.50 | $128.82 | $204.17 |
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 $660.69 Median $660.69 Typical High $660.69 | Professional | None | $660.69 | $660.69 | $660.69 |
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 $691.83 Median $954.99 Typical High $1,380.38 | Professional | None | $691.83 | $954.99 | $1,380.38 |
Martin's Point Setting Professional Modifier None Typical Low $645.65 Median $645.65 Typical High $660.69 | Professional | None | $645.65 | $645.65 | $660.69 |
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 $676.08 Median $954.99 Typical High $1,445.44 | Professional | None | $676.08 | $954.99 | $1,445.44 |
8 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 54 · Surgery only Typical Low $478.63 Median $489.78 Typical High $524.81 | Professional | 54 · Surgery only | $478.63 | $489.78 | $524.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $97.72 Typical High $104.71 | Professional | 55 · Aftercare only | $95.50 | $97.72 | $104.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $64.57 Median $64.57 Typical High $69.18 | Professional | 56 · Pre-op care only | $64.57 | $64.57 | $69.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $446.68 Median $457.09 Typical High $489.78 | Professional | 78 · Unplanned return to OR | $446.68 | $457.09 | $489.78 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $489.78 Median $489.78 Typical High $501.19 | Professional | 54 · Surgery only | $489.78 | $489.78 | $501.19 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $97.72 Median $97.72 Typical High $100.00 | Professional | 55 · Aftercare only | $97.72 | $97.72 | $100.00 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $64.57 Median $64.57 Typical High $66.07 | Professional | 56 · Pre-op care only | $64.57 | $64.57 | $66.07 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $457.09 Median $457.09 Typical High $467.74 | Professional | 78 · Unplanned return to OR | $457.09 | $457.09 | $467.74 |
Where Maine sits
The same service costs 3.8 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· 24th of 51
$794
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.