How much rates vary
Facilitymedian $10,471 · 10th to 90th $1,445 to $25,704Professionalmedian $1,479 · 10th to 90th $1,175 to $2,188
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 $1,318.26 Median $5,011.87 Typical High $16,595.87 | Facility | None | $1,318.26 | $5,011.87 | $16,595.87 |
Aetna Setting Professional Modifier None Typical Low $1,318.26 Median $1,348.96 Typical High $1,862.09 | Professional | None | $1,318.26 | $1,348.96 | $1,862.09 |
Ambetter Setting Professional Modifier 80 · Assistant surgeon Typical Low $169.82 Median $169.82 Typical High $169.82 | Professional | 80 · Assistant surgeon | $169.82 | $169.82 | $169.82 |
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 $1,174.90 Median $1,698.24 Typical High $1,949.84 | Professional | None | $1,174.90 | $1,698.24 | $1,949.84 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $741.31 Median $1,071.52 Typical High $1,230.27 | Professional | 62 · Two surgeons | $741.31 | $1,071.52 | $1,230.27 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $186.21 Median $275.42 Typical High $354.81 | Professional | 80 · Assistant surgeon | $186.21 | $275.42 | $354.81 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $162.18 Median $239.88 Typical High $269.15 | Professional | AS · PA/NP assist | $162.18 | $239.88 | $269.15 |
CareSource Setting Facility Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $1,412.54 | Facility | None | $1,412.54 | $1,412.54 | $1,412.54 |
CareSource Setting Professional Modifier None Typical Low $1,148.15 Median $1,148.15 Typical High $1,148.15 | Professional | None | $1,148.15 | $1,148.15 | $1,148.15 |
Cigna Setting Facility Modifier None Typical Low $575.44 Median $851.14 Typical High $2,691.53 | Facility | None | $575.44 | $851.14 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,318.26 Median $1,548.82 Typical High $2,630.27 | Professional | None | $1,318.26 | $1,548.82 | $2,630.27 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $912.01 Median $2,290.87 Typical High $3,630.78 | Facility | None | $912.01 | $2,290.87 | $3,630.78 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $1,445.44 Median $1,905.46 Typical High $2,344.23 | Professional | None | $1,445.44 | $1,905.46 | $2,344.23 |
United Setting Facility Modifier None Typical Low $1,202.26 Median $4,570.88 Typical High $12,022.64 | Facility | None | $1,202.26 | $4,570.88 | $12,022.64 |
United Setting Professional Modifier None Typical Low $1,174.90 Median $1,445.44 Typical High $2,187.76 | Professional | None | $1,174.90 | $1,445.44 | $2,187.76 |
7 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 $660.69 Median $660.69 Typical High $912.01 | Professional | 52 · Reduced service | $660.69 | $660.69 | $912.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $263.03 Typical High $363.08 | Professional | 53 · Discontinued | $263.03 | $263.03 | $363.08 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,000.00 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,000.00 | $1,000.00 | $1,380.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $199.53 Typical High $275.42 | Professional | 55 · Aftercare only | $199.53 | $199.53 | $275.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $131.83 Typical High $181.97 | Professional | 56 · Pre-op care only | $131.83 | $131.83 | $181.97 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $933.25 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $933.25 | $933.25 | $1,288.25 |
Ambetter Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,071.52 Typical High $1,071.52 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,071.52 | $1,071.52 |
Where Indiana sits
The same service costs 8.5 times more in Maine than in Delaware. 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 $28,081DE $3,299
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.