How much rates vary
Facilitymedian $2,692 · 10th to 90th $525 to $9,772Professionalmedian $1,259 · 10th to 90th $1,023 to $7,762
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 $1,230.27 Median $4,897.79 Typical High $7,762.47 | Facility | None | $1,230.27 | $4,897.79 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $977.24 Median $1,071.52 Typical High $1,202.26 | Professional | None | $977.24 | $1,071.52 | $1,202.26 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,513.56 Median $3,981.07 Typical High $10,471.29 | Facility | None | $1,513.56 | $3,981.07 | $10,471.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,047.13 Median $1,230.27 Typical High $1,778.28 | Professional | None | $1,047.13 | $1,230.27 | $1,778.28 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $660.69 Median $776.25 Typical High $1,096.48 | Professional | 62 · Two surgeons | $660.69 | $776.25 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $169.82 Median $199.53 Typical High $281.84 | Professional | 80 · Assistant surgeon | $169.82 | $199.53 | $281.84 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $147.91 Median $173.78 Typical High $245.47 | Professional | AS · PA/NP assist | $147.91 | $173.78 | $245.47 |
BCBS Kansas City Setting Professional Modifier None Typical Low $1,000.00 Median $1,122.02 Typical High $1,584.89 | Professional | None | $1,000.00 | $1,122.02 | $1,584.89 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $691.83 Typical High $2,691.53 | Facility | None | $489.78 | $691.83 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,023.29 Median $1,174.90 Typical High $2,137.96 | Professional | None | $1,023.29 | $1,174.90 | $2,137.96 |
Medica Setting Facility Modifier None Typical Low $54.95 Median $1,230.27 Typical High $9,772.37 | Facility | None | $54.95 | $1,230.27 | $9,772.37 |
Medica Setting Professional Modifier None Typical Low $1,258.93 Median $7,762.47 Typical High $7,762.47 | Professional | None | $1,258.93 | $7,762.47 | $7,762.47 |
United Setting Facility Modifier None Typical Low $467.74 Median $2,290.87 Typical High $10,964.78 | Facility | None | $467.74 | $2,290.87 | $10,964.78 |
United Setting Professional Modifier None Typical Low $1,023.29 Median $1,479.11 Typical High $2,570.40 | Professional | None | $1,023.29 | $1,479.11 | $2,570.40 |
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 $489.78 Median $524.81 Typical High $602.56 | Professional | 52 · Reduced service | $489.78 | $524.81 | $602.56 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $194.98 Median $208.93 Typical High $239.88 | Professional | 53 · Discontinued | $194.98 | $208.93 | $239.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $741.31 Median $794.33 Typical High $891.25 | Professional | 54 · Surgery only | $741.31 | $794.33 | $891.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $147.91 Median $158.49 Typical High $177.83 | Professional | 55 · Aftercare only | $147.91 | $158.49 | $177.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $97.72 Median $104.71 Typical High $120.23 | Professional | 56 · Pre-op care only | $97.72 | $104.71 | $120.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $691.83 Median $741.31 Typical High $831.76 | Professional | 78 · Unplanned return to OR | $691.83 | $741.31 | $831.76 |
Where Missouri sits
The same service costs 10.2 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 $17,229MD $1,684
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.