How much rates vary
Facilitymedian $2,455 · 10th to 90th $457 to $9,772Professionalmedian $1,862 · 10th to 90th $1,445 to $2,754
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 $1,949.84 Median $2,041.74 Typical High $2,454.71 | Facility | None | $1,949.84 | $2,041.74 | $2,454.71 |
Aetna Setting Professional Modifier None Typical Low $1,949.84 Median $1,995.26 Typical High $2,454.71 | Professional | None | $1,949.84 | $1,995.26 | $2,454.71 |
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 $1,445.44 Median $1,737.80 Typical High $2,187.76 | Professional | None | $1,445.44 | $1,737.80 | $2,187.76 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $891.25 Median $1,096.48 Typical High $1,380.38 | Professional | 62 · Two surgeons | $891.25 | $1,096.48 | $1,380.38 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $229.09 Median $275.42 Typical High $346.74 | Professional | 80 · Assistant surgeon | $229.09 | $275.42 | $346.74 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $199.53 Median $245.47 Typical High $302.00 | Professional | AS · PA/NP assist | $199.53 | $245.47 | $302.00 |
CareSource Setting Facility Modifier None Typical Low $1,584.89 Median $1,862.09 Typical High $2,951.21 | Facility | None | $1,584.89 | $1,862.09 | $2,951.21 |
CareSource Setting Professional Modifier None Typical Low $1,659.59 Median $2,290.87 Typical High $2,951.21 | Professional | None | $1,659.59 | $2,290.87 | $2,951.21 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $512.86 Typical High $3,235.94 | Facility | None | $34.67 | $512.86 | $3,235.94 |
Cigna Setting Professional Modifier None Typical Low $1,905.46 Median $2,187.76 Typical High $10,715.19 | Professional | None | $1,905.46 | $2,187.76 | $10,715.19 |
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 $1,778.28 Median $2,454.71 Typical High $3,090.30 | Professional | None | $1,778.28 | $2,454.71 | $3,090.30 |
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 $1,000.00 Typical High $1,230.27 | Professional | 52 · Reduced service | $977.24 | $1,000.00 | $1,230.27 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $389.05 Median $398.11 Typical High $489.78 | Professional | 53 · Discontinued | $389.05 | $398.11 | $489.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,479.11 Typical High $1,862.09 | Professional | 54 · Surgery only | $1,445.44 | $1,479.11 | $1,862.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $295.12 Typical High $371.54 | Professional | 55 · Aftercare only | $288.40 | $295.12 | $371.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $194.98 Median $199.53 Typical High $245.47 | Professional | 56 · Pre-op care only | $194.98 | $199.53 | $245.47 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,380.38 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,380.38 | $1,737.80 |
Where Kentucky 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.