How much rates vary
Facilitymedian $3,388 · 10th to 90th $501 to $12,589Professionalmedian $1,585 · 10th to 90th $219 to $2,344
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 $1,737.80 Median $10,232.93 Typical High $13,803.84 | Facility | None | $1,737.80 | $10,232.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $1,737.80 Median $1,737.80 Typical High $5,011.87 | Professional | None | $1,737.80 | $1,737.80 | $5,011.87 |
Ambetter Setting Professional Modifier None Typical Low $1,445.44 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,445.44 | $1,445.44 | $1,445.44 |
Anthem BCBS Setting Facility Modifier None Typical Low $891.25 Median $6,606.93 Typical High $13,803.84 | Facility | None | $891.25 | $6,606.93 | $13,803.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,348.96 Median $1,584.89 Typical High $2,238.72 | Professional | None | $1,348.96 | $1,584.89 | $2,238.72 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $851.14 Median $1,000.00 Typical High $1,412.54 | Professional | 62 · Two surgeons | $851.14 | $1,000.00 | $1,412.54 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $213.80 Median $251.19 Typical High $363.08 | Professional | 80 · Assistant surgeon | $213.80 | $251.19 | $363.08 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $186.21 Median $218.78 Typical High $316.23 | Professional | AS · PA/NP assist | $186.21 | $218.78 | $316.23 |
CareSource Setting Facility Modifier None Typical Low $2,187.76 Median $2,187.76 Typical High $2,187.76 | Facility | None | $2,187.76 | $2,187.76 | $2,187.76 |
CareSource Setting Professional Modifier None Typical Low $1,862.09 Median $1,862.09 Typical High $2,089.30 | Professional | None | $1,862.09 | $1,862.09 | $2,089.30 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,691.53 | Facility | None | $426.58 | $588.84 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,621.81 Median $1,862.09 Typical High $2,884.03 | Professional | None | $1,621.81 | $1,862.09 | $2,884.03 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $2,691.53 | Facility | None | $426.58 | $602.56 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1,698.24 Median $1,862.09 Typical High $2,884.03 | Professional | None | $1,698.24 | $1,862.09 | $2,884.03 |
Molina Setting Professional Modifier None Typical Low $165.96 Median $1,380.38 Typical High $2,187.76 | Professional | None | $165.96 | $1,380.38 | $2,187.76 |
SummaCare Setting Professional Modifier None Typical Low $1,698.24 Median $1,698.24 Typical High $1,949.84 | Professional | None | $1,698.24 | $1,698.24 | $1,949.84 |
United Setting Facility Modifier None Typical Low $371.54 Median $977.24 Typical High $4,677.35 | Facility | None | $371.54 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $1,380.38 Median $1,862.09 Typical High $2,884.03 | Professional | None | $1,380.38 | $1,862.09 | $2,884.03 |
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 $870.96 Median $870.96 Typical High $1,148.15 | Professional | 52 · Reduced service | $870.96 | $870.96 | $1,148.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $346.74 Median $346.74 Typical High $467.74 | Professional | 53 · Discontinued | $346.74 | $346.74 | $467.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,318.26 Median $1,318.26 Typical High $1,737.80 | Professional | 54 · Surgery only | $1,318.26 | $1,318.26 | $1,737.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $263.03 Median $263.03 Typical High $346.74 | Professional | 55 · Aftercare only | $263.03 | $263.03 | $346.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $173.78 Median $173.78 Typical High $229.09 | Professional | 56 · Pre-op care only | $173.78 | $173.78 | $229.09 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,230.27 Median $1,230.27 Typical High $1,621.81 | Professional | 78 · Unplanned return to OR | $1,230.27 | $1,230.27 | $1,621.81 |
Where Ohio 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.