How much rates vary
Facilitymedian $2,291 · 10th to 90th $759 to $10,715Professionalmedian $1,349 · 10th to 90th $1,122 to $1,995
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 $891.25 Median $1,479.11 Typical High $8,511.38 | Facility | None | $891.25 | $1,479.11 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,318.26 Median $1,380.38 Typical High $1,698.24 | Professional | None | $1,318.26 | $1,380.38 | $1,698.24 |
Ambetter Setting Professional Modifier None Typical Low $1,380.38 Median $1,380.38 Typical High $1,380.38 | Professional | None | $1,380.38 | $1,380.38 | $1,380.38 |
Anthem BCBS Setting Facility Modifier None Typical Low $5,888.44 Median $10,000.00 Typical High $16,218.10 | Facility | None | $5,888.44 | $10,000.00 | $16,218.10 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,122.02 Median $1,348.96 Typical High $1,862.09 | Professional | None | $1,122.02 | $1,348.96 | $1,862.09 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $707.95 Median $851.14 Typical High $1,174.90 | Professional | 62 · Two surgeons | $707.95 | $851.14 | $1,174.90 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $177.83 Median $218.78 Typical High $302.00 | Professional | 80 · Assistant surgeon | $177.83 | $218.78 | $302.00 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $154.88 Median $190.55 Typical High $263.03 | Professional | AS · PA/NP assist | $154.88 | $190.55 | $263.03 |
CareSource Setting Facility Modifier None Typical Low $1,096.48 Median $1,318.26 Typical High $2,041.74 | Facility | None | $1,096.48 | $1,318.26 | $2,041.74 |
CareSource Setting Professional Modifier None Typical Low $1,258.93 Median $1,621.81 Typical High $2,041.74 | Professional | None | $1,258.93 | $1,621.81 | $2,041.74 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $512.86 Typical High $2,290.87 | Facility | None | $34.67 | $512.86 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,318.26 Median $1,513.56 Typical High $7,762.47 | Professional | None | $1,318.26 | $1,513.56 | $7,762.47 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
United Setting Facility Modifier None Typical Low $831.76 Median $2,089.30 Typical High $6,760.83 | Facility | None | $831.76 | $2,089.30 | $6,760.83 |
United Setting Professional Modifier None Typical Low $1,258.93 Median $1,698.24 Typical High $2,137.96 | Professional | None | $1,258.93 | $1,698.24 | $2,137.96 |
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 $676.08 Median $691.83 Typical High $851.14 | Professional | 52 · Reduced service | $676.08 | $691.83 | $851.14 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $275.42 Typical High $338.84 | Professional | 53 · Discontinued | $269.15 | $275.42 | $338.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,023.29 Typical High $1,288.25 | Professional | 54 · Surgery only | $1,000.00 | $1,023.29 | $1,288.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $208.93 Typical High $257.04 | Professional | 55 · Aftercare only | $204.17 | $208.93 | $257.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $138.04 Typical High $169.82 | Professional | 56 · Pre-op care only | $134.90 | $138.04 | $169.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $954.99 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $933.25 | $954.99 | $1,202.26 |
Where Kentucky 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.