How much rates vary
Facilitymedian $5,370 · 10th to 90th $1,122 to $19,953Professionalmedian $1,622 · 10th to 90th $1,288 to $2,455
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 $1,621.81 Median $5,495.41 Typical High $14,125.38 | Facility | None | $1,621.81 | $5,495.41 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $1,584.89 Median $1,621.81 Typical High $3,019.95 | Professional | None | $1,584.89 | $1,621.81 | $3,019.95 |
Anthem BCBS Setting Facility Modifier None Typical Low $5,248.07 Median $12,589.25 Typical High $23,442.29 | Facility | None | $5,248.07 | $12,589.25 | $23,442.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,288.25 Median $1,548.82 Typical High $1,995.26 | Professional | None | $1,288.25 | $1,548.82 | $1,995.26 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $812.83 Median $977.24 Typical High $1,258.93 | Professional | 62 · Two surgeons | $812.83 | $977.24 | $1,258.93 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $204.17 Median $245.47 Typical High $323.59 | Professional | 80 · Assistant surgeon | $204.17 | $245.47 | $323.59 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $181.97 Median $213.80 Typical High $281.84 | Professional | AS · PA/NP assist | $181.97 | $213.80 | $281.84 |
CareFirst Setting Professional Modifier None Typical Low $1,513.56 Median $1,659.59 Typical High $2,187.76 | Professional | None | $1,513.56 | $1,659.59 | $2,187.76 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,174.90 Typical High $5,495.41 | Facility | None | $501.19 | $1,174.90 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $1,318.26 Median $1,548.82 Typical High $2,398.83 | Professional | None | $1,318.26 | $1,548.82 | $2,398.83 |
Kaiser Permanente Setting Professional Modifier None Typical Low $1,258.93 Median $1,513.56 Typical High $1,862.09 | Professional | None | $1,258.93 | $1,513.56 | $1,862.09 |
Medcost Setting Professional Modifier None Typical Low $1,659.59 Median $2,089.30 Typical High $2,089.30 | Professional | None | $1,659.59 | $2,089.30 | $2,089.30 |
Medcost Setting Facility Modifier None Typical Low $1,584.89 Median $1,949.84 Typical High $2,570.40 | Facility | None | $1,584.89 | $1,949.84 | $2,570.40 |
Medcost Setting Professional Modifier None Typical Low $1,819.70 Median $1,819.70 Typical High $1,819.70 | Professional | None | $1,819.70 | $1,819.70 | $1,819.70 |
Sentara Setting Facility Modifier None Typical Low $1,047.13 Median $1,995.26 Typical High $7,413.10 | Facility | None | $1,047.13 | $1,995.26 | $7,413.10 |
Sentara Setting Professional Modifier None Typical Low $1,288.25 Median $1,778.28 Typical High $3,388.44 | Professional | None | $1,288.25 | $1,778.28 | $3,388.44 |
United Setting Facility Modifier None Typical Low $436.52 Median $2,344.23 Typical High $6,309.57 | Facility | None | $436.52 | $2,344.23 | $6,309.57 |
United Setting Professional Modifier None Typical Low $1,148.15 Median $1,737.80 Typical High $2,754.23 | Professional | None | $1,148.15 | $1,737.80 | $2,754.23 |
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 $758.58 Median $794.33 Typical High $812.83 | Professional | 52 · Reduced service | $758.58 | $794.33 | $812.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $316.23 Typical High $323.59 | Professional | 53 · Discontinued | $302.00 | $316.23 | $323.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $1,174.90 Typical High $1,230.27 | Professional | 54 · Surgery only | $1,122.02 | $1,174.90 | $1,230.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $234.42 Typical High $245.47 | Professional | 55 · Aftercare only | $229.09 | $234.42 | $245.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $158.49 Typical High $162.18 | Professional | 56 · Pre-op care only | $151.36 | $158.49 | $162.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,096.48 Typical High $1,148.15 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,096.48 | $1,148.15 |
Where Virginia sits
The same service costs 13.5 times more in Maine than in Washington. 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 $28,253WA $2,096
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.