How much rates vary
Facilitymedian $3,631 · 10th to 90th $776 to $16,218Professionalmedian $3,236 · 10th to 90th $1,995 to $5,012
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 $2,398.83 Median $2,398.83 Typical High $9,772.37 | Facility | None | $2,398.83 | $2,398.83 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $1,905.46 Median $1,995.26 Typical High $2,344.23 | Professional | None | $1,905.46 | $1,995.26 | $2,344.23 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,890.45 Median $10,000.00 Typical High $16,982.44 | Facility | None | $3,890.45 | $10,000.00 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $2,137.96 Median $3,548.13 Typical High $4,677.35 | Professional | None | $2,137.96 | $3,548.13 | $4,677.35 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,288.25 Median $2,137.96 Typical High $2,884.03 | Professional | 62 · Two surgeons | $1,288.25 | $2,137.96 | $2,884.03 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $323.59 Median $537.03 Typical High $724.44 | Professional | 80 · Assistant surgeon | $323.59 | $537.03 | $724.44 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $281.84 Median $467.74 Typical High $630.96 | Professional | AS · PA/NP assist | $281.84 | $467.74 | $630.96 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $630.96 Typical High $2,691.53 | Facility | None | $489.78 | $630.96 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $2,187.76 Median $3,630.78 Typical High $5,248.07 | Professional | None | $2,187.76 | $3,630.78 | $5,248.07 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $851.14 Typical High $2,884.03 | Facility | None | $776.25 | $851.14 | $2,884.03 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2,041.74 Median $2,754.23 Typical High $5,495.41 | Professional | None | $2,041.74 | $2,754.23 | $5,495.41 |
United Setting Facility Modifier None Typical Low $776.25 Median $933.25 Typical High $2,884.03 | Facility | None | $776.25 | $933.25 | $2,884.03 |
United Setting Professional Modifier None Typical Low $2,089.30 Median $2,754.23 Typical High $5,495.41 | Professional | None | $2,089.30 | $2,754.23 | $5,495.41 |
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 $954.99 Median $1,000.00 Typical High $1,148.15 | Professional | 52 · Reduced service | $954.99 | $1,000.00 | $1,148.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $380.19 Median $398.11 Typical High $467.74 | Professional | 53 · Discontinued | $380.19 | $398.11 | $467.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,445.44 Median $1,513.56 Typical High $1,737.80 | Professional | 54 · Surgery only | $1,445.44 | $1,513.56 | $1,737.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $288.40 Median $302.00 Typical High $346.74 | Professional | 55 · Aftercare only | $288.40 | $302.00 | $346.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $190.55 Median $199.53 Typical High $234.42 | Professional | 56 · Pre-op care only | $190.55 | $199.53 | $234.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,348.96 Median $1,412.54 Typical High $1,621.81 | Professional | 78 · Unplanned return to OR | $1,348.96 | $1,412.54 | $1,621.81 |
Where New Hampshire 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.