How much rates vary
Facilitymedian $4,677 · 10th to 90th $676 to $13,490Professionalmedian $1,862 · 10th to 90th $1,047 to $2,884
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 $1,071.52 Median $1,659.59 Typical High $1,659.59 | Professional | None | $1,071.52 | $1,659.59 | $1,659.59 |
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 $1,071.52 Median $2,187.76 Typical High $2,951.21 | Professional | None | $1,071.52 | $2,187.76 | $2,951.21 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $676.08 Median $1,380.38 Typical High $1,862.09 | Professional | 62 · Two surgeons | $676.08 | $1,380.38 | $1,862.09 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $173.78 Median $346.74 Typical High $467.74 | Professional | 80 · Assistant surgeon | $173.78 | $346.74 | $467.74 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $151.36 Median $309.03 Typical High $407.38 | Professional | AS · PA/NP assist | $151.36 | $309.03 | $407.38 |
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 $1,318.26 Median $1,513.56 Typical High $2,454.71 | Professional | None | $1,318.26 | $1,513.56 | $2,454.71 |
ConnectiCare Setting Professional Modifier None Typical Low $1,318.26 Median $1,659.59 Typical High $1,862.09 | Professional | None | $1,318.26 | $1,659.59 | $1,862.09 |
Health New England Setting Professional Modifier None Typical Low $2,630.27 Median $2,630.27 Typical High $2,630.27 | Professional | None | $2,630.27 | $2,630.27 | $2,630.27 |
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 $977.24 Median $1,698.24 Typical High $3,890.45 | Professional | None | $977.24 | $1,698.24 | $3,890.45 |
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 $537.03 Median $831.76 Typical High $831.76 | Professional | 52 · Reduced service | $537.03 | $831.76 | $831.76 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $218.78 Median $331.13 Typical High $331.13 | Professional | 53 · Discontinued | $218.78 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $1,230.27 Typical High $1,230.27 | Professional | 54 · Surgery only | $812.83 | $1,230.27 | $1,230.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $162.18 Median $245.47 Typical High $245.47 | Professional | 55 · Aftercare only | $162.18 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $165.96 Typical High $165.96 | Professional | 56 · Pre-op care only | $109.65 | $165.96 | $165.96 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $1,148.15 Typical High $1,148.15 | Professional | 78 · Unplanned return to OR | $758.58 | $1,148.15 | $1,148.15 |
Where Connecticut sits
The same service costs 10.0 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 $17,294MD $1,737
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.