How much rates vary
Facilitymedian $4,677 · 10th to 90th $676 to $13,490Professionalmedian $3,311 · 10th to 90th $1,905 to $5,129
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 $4,365.16 Median $5,754.40 Typical High $8,511.38 | Facility | None | $4,365.16 | $5,754.40 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,949.84 Median $2,951.21 Typical High $2,951.21 | Professional | None | $1,949.84 | $2,951.21 | $2,951.21 |
Anthem BCBS Setting Facility Modifier None Typical Low $4,073.80 Median $12,022.64 Typical High $14,125.38 | Facility | None | $4,073.80 | $12,022.64 | $14,125.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,949.84 Median $3,890.45 Typical High $5,128.61 | Professional | None | $1,949.84 | $3,890.45 | $5,128.61 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,202.26 Median $2,454.71 Typical High $3,235.94 | Professional | 62 · Two surgeons | $1,202.26 | $2,454.71 | $3,235.94 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $309.03 Median $616.60 Typical High $831.76 | Professional | 80 · Assistant surgeon | $309.03 | $616.60 | $831.76 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $275.42 Median $537.03 Typical High $724.44 | Professional | AS · PA/NP assist | $275.42 | $537.03 | $724.44 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,000.00 Typical High $27,542.29 | Facility | None | $501.19 | $1,000.00 | $27,542.29 |
Cigna Setting Professional Modifier None Typical Low $2,398.83 Median $2,691.53 Typical High $4,365.16 | Professional | None | $2,398.83 | $2,691.53 | $4,365.16 |
ConnectiCare Setting Professional Modifier None Typical Low $2,344.23 Median $2,951.21 Typical High $3,311.31 | Professional | None | $2,344.23 | $2,951.21 | $3,311.31 |
United Setting Facility Modifier None Typical Low $537.03 Median $1,258.93 Typical High $7,413.10 | Facility | None | $537.03 | $1,258.93 | $7,413.10 |
United Setting Professional Modifier None Typical Low $1,778.28 Median $3,162.28 Typical High $6,918.31 | Professional | None | $1,778.28 | $3,162.28 | $6,918.31 |
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 $977.24 Median $1,479.11 Typical High $1,479.11 | Professional | 52 · Reduced service | $977.24 | $1,479.11 | $1,479.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $588.84 Typical High $588.84 | Professional | 53 · Discontinued | $389.05 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,479.11 Median $2,238.72 Typical High $2,238.72 | Professional | 54 · Surgery only | $1,479.11 | $2,238.72 | $2,238.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $295.12 Median $446.68 Typical High $446.68 | Professional | 55 · Aftercare only | $295.12 | $446.68 | $446.68 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $295.12 Typical High $295.12 | Professional | 56 · Pre-op care only | $194.98 | $295.12 | $295.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,380.38 Median $2,089.30 Typical High $2,089.30 | Professional | 78 · Unplanned return to OR | $1,380.38 | $2,089.30 | $2,089.30 |
Where Connecticut sits
The same service costs 6.9 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 $18,419MD $2,652
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.