How much rates vary
Facilitymedian $3,388 · 10th to 90th $490 to $12,589Professionalmedian $1,862 · 10th to 90th $219 to $2,692
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 $1,995.26 Median $10,232.93 Typical High $13,803.84 | Facility | None | $1,995.26 | $10,232.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $1,995.26 Median $1,995.26 Typical High $6,456.54 | Professional | None | $1,995.26 | $1,995.26 | $6,456.54 |
Ambetter Setting Professional Modifier None Typical Low $812.83 Median $812.83 Typical High $812.83 | Professional | None | $812.83 | $812.83 | $812.83 |
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 $1,584.89 Median $1,862.09 Typical High $2,630.27 | Professional | None | $1,584.89 | $1,862.09 | $2,630.27 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,000.00 Median $1,174.90 Typical High $1,659.59 | Professional | 62 · Two surgeons | $1,000.00 | $1,174.90 | $1,659.59 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $251.19 Median $295.12 Typical High $426.58 | Professional | 80 · Assistant surgeon | $251.19 | $295.12 | $426.58 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $218.78 Median $257.04 Typical High $363.08 | Professional | AS · PA/NP assist | $218.78 | $257.04 | $363.08 |
CareSource Setting Facility Modifier None Typical Low $2,454.71 Median $2,454.71 Typical High $2,454.71 | Facility | None | $2,454.71 | $2,454.71 | $2,454.71 |
CareSource Setting Professional Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,398.83 | Professional | None | $2,089.30 | $2,089.30 | $2,398.83 |
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 $1,905.46 Median $2,137.96 Typical High $3,388.44 | Professional | None | $1,905.46 | $2,137.96 | $3,388.44 |
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 $1,905.46 Median $2,137.96 Typical High $3,388.44 | Professional | None | $1,905.46 | $2,137.96 | $3,388.44 |
Molina Setting Professional Modifier None Typical Low $165.96 Median $1,584.89 Typical High $2,511.89 | Professional | None | $165.96 | $1,584.89 | $2,511.89 |
SummaCare Setting Professional Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $2,238.72 | Professional | None | $1,905.46 | $1,905.46 | $2,238.72 |
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 $1,621.81 Median $2,137.96 Typical High $3,235.94 | Professional | None | $1,621.81 | $2,137.96 | $3,235.94 |
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 $1,000.00 Median $1,000.00 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,000.00 | $1,000.00 | $1,318.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $398.11 Median $398.11 Typical High $524.81 | Professional | 53 · Discontinued | $398.11 | $398.11 | $524.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,479.11 Median $1,479.11 Typical High $1,995.26 | Professional | 54 · Surgery only | $1,479.11 | $1,479.11 | $1,995.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $295.12 Median $295.12 Typical High $398.11 | Professional | 55 · Aftercare only | $295.12 | $295.12 | $398.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $199.53 Median $199.53 Typical High $263.03 | Professional | 56 · Pre-op care only | $199.53 | $199.53 | $263.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,380.38 Median $1,380.38 Typical High $1,862.09 | Professional | 78 · Unplanned return to OR | $1,380.38 | $1,380.38 | $1,862.09 |
Where Ohio 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.