How much rates vary
Facilitymedian $1,995 · 10th to 90th $457 to $9,772Professionalmedian $1,479 · 10th to 90th $1,148 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 $1,513.56 Median $1,584.89 Typical High $1,905.46 | Facility | None | $1,513.56 | $1,584.89 | $1,905.46 |
Aetna Setting Professional Modifier None Typical Low $1,513.56 Median $1,548.82 Typical High $1,905.46 | Professional | None | $1,513.56 | $1,548.82 | $1,905.46 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,548.13 Median $6,025.60 Typical High $11,220.18 | Facility | None | $3,548.13 | $6,025.60 | $11,220.18 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,122.02 Median $1,348.96 Typical High $1,698.24 | Professional | None | $1,122.02 | $1,348.96 | $1,698.24 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $707.95 Median $851.14 Typical High $1,348.96 | Professional | 62 · Two surgeons | $707.95 | $851.14 | $1,348.96 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $181.97 Median $218.78 Typical High $275.42 | Professional | 80 · Assistant surgeon | $181.97 | $218.78 | $275.42 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $158.49 Median $190.55 Typical High $239.88 | Professional | AS · PA/NP assist | $158.49 | $190.55 | $239.88 |
CareSource Setting Facility Modifier None Typical Low $1,230.27 Median $1,479.11 Typical High $2,290.87 | Facility | None | $1,230.27 | $1,479.11 | $2,290.87 |
CareSource Setting Professional Modifier None Typical Low $1,288.25 Median $1,778.28 Typical High $2,290.87 | Professional | None | $1,288.25 | $1,778.28 | $2,290.87 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $512.86 Typical High $2,570.40 | Facility | None | $34.67 | $512.86 | $2,570.40 |
Cigna Setting Professional Modifier None Typical Low $1,479.11 Median $1,698.24 Typical High $8,317.64 | Professional | None | $1,479.11 | $1,698.24 | $8,317.64 |
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 $354.81 Median $912.01 Typical High $8,317.64 | Facility | None | $354.81 | $912.01 | $8,317.64 |
United Setting Professional Modifier None Typical Low $1,412.54 Median $1,905.46 Typical High $2,398.83 | Professional | None | $1,412.54 | $1,905.46 | $2,398.83 |
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 $758.58 Median $776.25 Typical High $954.99 | Professional | 52 · Reduced service | $758.58 | $776.25 | $954.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $309.03 Typical High $380.19 | Professional | 53 · Discontinued | $302.00 | $309.03 | $380.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,122.02 Median $1,174.90 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,122.02 | $1,174.90 | $1,445.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $234.42 Typical High $288.40 | Professional | 55 · Aftercare only | $223.87 | $234.42 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $154.88 Typical High $190.55 | Professional | 56 · Pre-op care only | $151.36 | $154.88 | $190.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,096.48 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,047.13 | $1,096.48 | $1,348.96 |
Where Kentucky 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.