How much rates vary
Facilitymedian $3,631 · 10th to 90th $776 to $16,218Professionalmedian $2,455 · 10th to 90th $1,778 to $4,169
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 $2,398.83 Median $2,398.83 Typical High $9,772.37 | Facility | None | $2,398.83 | $2,398.83 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $1,698.24 Median $1,778.28 Typical High $2,089.30 | Professional | None | $1,698.24 | $1,778.28 | $2,089.30 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,890.45 Median $10,000.00 Typical High $16,982.44 | Facility | None | $3,890.45 | $10,000.00 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,698.24 Median $2,818.38 Typical High $3,548.13 | Professional | None | $1,698.24 | $2,818.38 | $3,548.13 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,148.15 Median $1,513.56 Typical High $2,089.30 | Professional | 62 · Two surgeons | $1,148.15 | $1,513.56 | $2,089.30 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $295.12 Median $389.05 Typical High $524.81 | Professional | 80 · Assistant surgeon | $295.12 | $389.05 | $524.81 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $257.04 Median $338.84 Typical High $457.09 | Professional | AS · PA/NP assist | $257.04 | $338.84 | $457.09 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $630.96 Typical High $2,691.53 | Facility | None | $489.78 | $630.96 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,819.70 Median $3,235.94 Typical High $4,677.35 | Professional | None | $1,819.70 | $3,235.94 | $4,677.35 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $851.14 Typical High $2,884.03 | Facility | None | $776.25 | $851.14 | $2,884.03 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,778.28 Median $2,454.71 Typical High $4,897.79 | Professional | None | $1,778.28 | $2,454.71 | $4,897.79 |
United Setting Facility Modifier None Typical Low $776.25 Median $933.25 Typical High $2,884.03 | Facility | None | $776.25 | $933.25 | $2,884.03 |
United Setting Professional Modifier None Typical Low $1,778.28 Median $2,454.71 Typical High $4,897.79 | Professional | None | $1,778.28 | $2,454.71 | $4,897.79 |
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 $851.14 Median $891.25 Typical High $1,023.29 | Professional | 52 · Reduced service | $851.14 | $891.25 | $1,023.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $354.81 Typical High $407.38 | Professional | 53 · Discontinued | $338.84 | $354.81 | $407.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $1,318.26 Typical High $1,548.82 | Professional | 54 · Surgery only | $1,258.93 | $1,318.26 | $1,548.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $263.03 Typical High $309.03 | Professional | 55 · Aftercare only | $257.04 | $263.03 | $309.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $177.83 Typical High $204.17 | Professional | 56 · Pre-op care only | $169.82 | $177.83 | $204.17 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $1,230.27 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $1,174.90 | $1,230.27 | $1,445.44 |
Where New Hampshire sits
The same service costs 7.6 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 $18,140MD $2,382
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.