How much rates vary
Facilitymedian $7,079 · 10th to 90th $794 to $15,488Professionalmedian $1,549 · 10th to 90th $1,318 to $2,239
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 $1,479.11 Median $3,467.37 Typical High $5,011.87 | Facility | None | $1,479.11 | $3,467.37 | $5,011.87 |
Aetna Setting Professional Modifier None Typical Low $1,479.11 Median $1,479.11 Typical High $2,041.74 | Professional | None | $1,479.11 | $1,479.11 | $2,041.74 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,659.59 Median $10,000.00 Typical High $16,982.44 | Facility | None | $1,659.59 | $10,000.00 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,230.27 Median $1,548.82 Typical High $1,778.28 | Professional | None | $1,230.27 | $1,548.82 | $1,778.28 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $776.25 Median $977.24 Typical High $1,174.90 | Professional | 62 · Two surgeons | $776.25 | $977.24 | $1,174.90 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $194.98 Median $245.47 Typical High $323.59 | Professional | 80 · Assistant surgeon | $194.98 | $245.47 | $323.59 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $173.78 Median $213.80 Typical High $257.04 | Professional | AS · PA/NP assist | $173.78 | $213.80 | $257.04 |
CareSource Setting Facility Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $1,584.89 | Facility | None | $1,584.89 | $1,584.89 | $1,584.89 |
CareSource Setting Professional Modifier None Typical Low $1,348.96 Median $1,348.96 Typical High $1,348.96 | Professional | None | $1,348.96 | $1,348.96 | $1,348.96 |
Cigna Setting Facility Modifier None Typical Low $512.86 Median $851.14 Typical High $2,691.53 | Facility | None | $512.86 | $851.14 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,412.54 Median $1,659.59 Typical High $2,951.21 | Professional | None | $1,412.54 | $1,659.59 | $2,951.21 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $912.01 Median $2,290.87 Typical High $4,073.80 | Facility | None | $912.01 | $2,290.87 | $4,073.80 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $1,621.81 Median $2,137.96 Typical High $2,630.27 | Professional | None | $1,621.81 | $2,137.96 | $2,630.27 |
United Setting Facility Modifier None Typical Low $302.00 Median $2,290.87 Typical High $10,232.93 | Facility | None | $302.00 | $2,290.87 | $10,232.93 |
United Setting Professional Modifier None Typical Low $1,318.26 Median $1,621.81 Typical High $2,454.71 | Professional | None | $1,318.26 | $1,621.81 | $2,454.71 |
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 $741.31 Median $741.31 Typical High $1,023.29 | Professional | 52 · Reduced service | $741.31 | $741.31 | $1,023.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $295.12 Typical High $407.38 | Professional | 53 · Discontinued | $295.12 | $295.12 | $407.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $1,122.02 Typical High $1,548.82 | Professional | 54 · Surgery only | $1,122.02 | $1,122.02 | $1,548.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $223.87 Typical High $309.03 | Professional | 55 · Aftercare only | $223.87 | $223.87 | $309.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $147.91 Typical High $204.17 | Professional | 56 · Pre-op care only | $147.91 | $147.91 | $204.17 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,047.13 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,047.13 | $1,445.44 |
Where Indiana sits
The same service costs 8.2 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 $17,891MD $2,184
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.