How much rates vary
Facilitymedian $10,000 · 10th to 90th $851 to $25,119Professionalmedian $813 · 10th to 90th $631 to $1,259
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 $870.96 Median $5,011.87 Typical High $14,125.38 | Facility | None | $870.96 | $5,011.87 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $794.33 Median $870.96 Typical High $1,071.52 | Professional | None | $794.33 | $870.96 | $1,071.52 |
Anthem BCBS Setting Facility Modifier None Typical Low $2,630.27 Median $18,197.01 Typical High $27,542.29 | Facility | None | $2,630.27 | $18,197.01 | $27,542.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $630.96 Median $741.31 Typical High $1,122.02 | Professional | None | $630.96 | $741.31 | $1,122.02 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $100.00 Median $117.49 Typical High $181.97 | Professional | 80 · Assistant surgeon | $100.00 | $117.49 | $181.97 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $87.10 Median $102.33 Typical High $158.49 | Professional | AS · PA/NP assist | $87.10 | $102.33 | $158.49 |
CareSource Setting Facility Modifier None Typical Low $794.33 Median $794.33 Typical High $794.33 | Facility | None | $794.33 | $794.33 | $794.33 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $1,230.27 Typical High $2,691.53 | Facility | None | $602.56 | $1,230.27 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $758.58 Median $977.24 Typical High $1,230.27 | Professional | None | $758.58 | $977.24 | $1,230.27 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $912.01 Median $977.24 Typical High $2,137.96 | Facility | None | $912.01 | $977.24 | $2,137.96 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $741.31 Median $977.24 Typical High $1,479.11 | Professional | None | $741.31 | $977.24 | $1,479.11 |
United Setting Facility Modifier None Typical Low $302.00 Median $2,290.87 Typical High $10,232.93 | Facility | None | $302.00 | $2,290.87 | $10,232.93 |
United Setting Professional Modifier None Typical Low $758.58 Median $1,096.48 Typical High $1,584.89 | Professional | None | $758.58 | $1,096.48 | $1,584.89 |
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 $398.11 Median $436.52 Typical High $489.78 | Professional | 52 · Reduced service | $398.11 | $436.52 | $489.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $177.83 Typical High $194.98 | Professional | 53 · Discontinued | $158.49 | $177.83 | $194.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $602.56 Median $660.69 Typical High $741.31 | Professional | 54 · Surgery only | $602.56 | $660.69 | $741.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $131.83 Typical High $147.91 | Professional | 55 · Aftercare only | $120.23 | $131.83 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $87.10 Typical High $97.72 | Professional | 56 · Pre-op care only | $79.43 | $87.10 | $97.72 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $616.60 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $562.34 | $616.60 | $691.83 |
Where Indiana sits
The same service costs 18.7 times more in Maine than in Maryland. 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 $26,826MD $1,433
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.