How much rates vary
Facilitymedian $3,388 · 10th to 90th $490 to $12,589Professionalmedian $1,413 · 10th to 90th $151 to $2,042
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 $1,548.82 Median $10,232.93 Typical High $13,803.84 | Facility | None | $1,548.82 | $10,232.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $1,548.82 Median $1,548.82 Typical High $5,128.61 | Professional | None | $1,548.82 | $1,548.82 | $5,128.61 |
Anthem BCBS Setting Facility Modifier None Typical Low $891.25 Median $6,606.93 Typical High $13,803.84 | Facility | None | $891.25 | $6,606.93 | $13,803.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,202.26 Median $1,412.54 Typical High $2,041.74 | Professional | None | $1,202.26 | $1,412.54 | $2,041.74 |
CareSource Setting Facility Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $1,905.46 | Facility | None | $1,905.46 | $1,905.46 | $1,905.46 |
CareSource Setting Professional Modifier None Typical Low $1,621.81 Median $1,621.81 Typical High $1,862.09 | Professional | None | $1,621.81 | $1,621.81 | $1,862.09 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,691.53 | Facility | None | $426.58 | $588.84 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,479.11 Median $1,659.59 Typical High $2,630.27 | Professional | None | $1,479.11 | $1,659.59 | $2,630.27 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $2,691.53 | Facility | None | $426.58 | $602.56 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1,479.11 Median $1,659.59 Typical High $2,630.27 | Professional | None | $1,479.11 | $1,659.59 | $2,630.27 |
Molina Setting Professional Modifier None Typical Low $134.90 Median $1,122.02 Typical High $1,905.46 | Professional | None | $134.90 | $1,122.02 | $1,905.46 |
SummaCare Setting Professional Modifier None Typical Low $1,479.11 Median $1,479.11 Typical High $1,737.80 | Professional | None | $1,479.11 | $1,479.11 | $1,737.80 |
United Setting Facility Modifier None Typical Low $371.54 Median $977.24 Typical High $4,677.35 | Facility | None | $371.54 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $1,258.93 Median $1,659.59 Typical High $2,511.89 | Professional | None | $1,258.93 | $1,659.59 | $2,511.89 |
10 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 $776.25 Median $776.25 Typical High $1,023.29 | Professional | 52 · Reduced service | $776.25 | $776.25 | $1,023.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $309.03 Typical High $407.38 | Professional | 53 · Discontinued | $309.03 | $309.03 | $407.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,174.90 Typical High $1,548.82 | Professional | 54 · Surgery only | $1,174.90 | $1,174.90 | $1,548.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $234.42 Typical High $309.03 | Professional | 55 · Aftercare only | $234.42 | $234.42 | $309.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $154.88 Typical High $204.17 | Professional | 56 · Pre-op care only | $154.88 | $154.88 | $204.17 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,096.48 Typical High $1,445.44 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,096.48 | $1,445.44 |
Ambetter Setting Professional Modifier 51 · Multiple procedures Typical Low $707.95 Median $707.95 Typical High $707.95 | Professional | 51 · Multiple procedures | $707.95 | $707.95 | $707.95 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $758.58 Median $891.25 Typical High $1,288.25 | Professional | 62 · Two surgeons | $758.58 | $891.25 | $1,288.25 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $194.98 Median $229.09 Typical High $331.13 | Professional | 80 · Assistant surgeon | $194.98 | $229.09 | $331.13 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $169.82 Median $199.53 Typical High $288.40 | Professional | AS · PA/NP assist | $169.82 | $199.53 | $288.40 |
Where Ohio 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.