How much rates vary
Facilitymedian $12,023 · 10th to 90th $1,380 to $25,704Professionalmedian $1,096 · 10th to 90th $708 to $1,660
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 Facility Modifier None Typical Low $758.58 Median $3,467.37 Typical High $5,011.87 | Facility | None | $758.58 | $3,467.37 | $5,011.87 |
Aetna Setting Professional Modifier None Typical Low $758.58 Median $758.58 Typical High $954.99 | Professional | None | $758.58 | $758.58 | $954.99 |
Anthem BCBS Setting Facility Modifier None Typical Low $2,238.72 Median $16,595.87 Typical High $27,542.29 | Facility | None | $2,238.72 | $16,595.87 | $27,542.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $707.95 Median $1,288.25 Typical High $1,737.80 | Professional | None | $707.95 | $1,288.25 | $1,737.80 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,047.13 Median $1,949.84 Typical High $2,630.27 | Professional | 50 · Both sides | $1,047.13 | $1,949.84 | $2,630.27 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $446.68 Median $812.83 Typical High $1,096.48 | Professional | 62 · Two surgeons | $446.68 | $812.83 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $112.20 Median $208.93 Typical High $295.12 | Professional | 80 · Assistant surgeon | $112.20 | $208.93 | $295.12 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $100.00 Median $181.97 Typical High $245.47 | Professional | AS · PA/NP assist | $100.00 | $181.97 | $245.47 |
CareSource Setting Facility Modifier None Typical Low $812.83 Median $812.83 Typical High $812.83 | Facility | None | $812.83 | $812.83 | $812.83 |
Cigna Setting Facility Modifier None Typical Low $562.34 Median $1,258.93 Typical High $2,691.53 | Facility | None | $562.34 | $1,258.93 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $794.33 Median $1,023.29 Typical High $1,737.80 | Professional | None | $794.33 | $1,023.29 | $1,737.80 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $912.01 Median $2,089.30 Typical High $2,238.72 | Facility | None | $912.01 | $2,089.30 | $2,238.72 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $851.14 Median $1,023.29 Typical High $1,548.82 | Professional | None | $851.14 | $1,023.29 | $1,548.82 |
United Setting Facility Modifier None Typical Low $1,621.81 Median $8,912.51 Typical High $16,218.10 | Facility | None | $1,621.81 | $8,912.51 | $16,218.10 |
United Setting Professional Modifier None Typical Low $741.31 Median $954.99 Typical High $1,412.54 | Professional | None | $741.31 | $954.99 | $1,412.54 |
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 $380.19 Median $380.19 Typical High $467.74 | Professional | 52 · Reduced service | $380.19 | $380.19 | $467.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $151.36 Median $151.36 Typical High $190.55 | Professional | 53 · Discontinued | $151.36 | $151.36 | $190.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $575.44 Median $575.44 Typical High $707.95 | Professional | 54 · Surgery only | $575.44 | $575.44 | $707.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $114.82 Typical High $141.25 | Professional | 55 · Aftercare only | $114.82 | $114.82 | $141.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $75.86 Typical High $95.50 | Professional | 56 · Pre-op care only | $75.86 | $75.86 | $95.50 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $537.03 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $537.03 | $537.03 | $660.69 |
Where Indiana sits
The same service costs 10.5 times more in Maine than in Massachusetts. 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.
Physician feeFacility fee
ME $27,425MA $2,607
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.