How much rates vary
Facilitymedian $4,169 · 10th to 90th $912 to $12,303Professionalmedian $1,202 · 10th to 90th $1,000 to $1,479
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 $1,288.25 Median $5,495.41 Typical High $14,125.38 | Facility | None | $1,288.25 | $5,495.41 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,288.25 | Professional | None | $1,258.93 | $1,258.93 | $1,288.25 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,162.28 Median $7,413.10 Typical High $14,125.38 | Facility | None | $3,162.28 | $7,413.10 | $14,125.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,047.13 Median $1,230.27 Typical High $1,479.11 | Professional | None | $1,047.13 | $1,230.27 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $660.69 Median $776.25 Typical High $933.25 | Professional | 62 · Two surgeons | $660.69 | $776.25 | $933.25 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $165.96 Median $194.98 Typical High $234.42 | Professional | 80 · Assistant surgeon | $165.96 | $194.98 | $234.42 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $144.54 Median $169.82 Typical High $204.17 | Professional | AS · PA/NP assist | $144.54 | $169.82 | $204.17 |
CareFirst Setting Professional Modifier None Typical Low $1,096.48 Median $1,202.26 Typical High $1,380.38 | Professional | None | $1,096.48 | $1,202.26 | $1,380.38 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,174.90 Typical High $5,495.41 | Facility | None | $501.19 | $1,174.90 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $1,000.00 Median $1,174.90 Typical High $1,621.81 | Professional | None | $1,000.00 | $1,174.90 | $1,621.81 |
Kaiser Permanente Setting Professional Modifier None Typical Low $1,000.00 Median $1,148.15 Typical High $1,778.28 | Professional | None | $1,000.00 | $1,148.15 | $1,778.28 |
Medcost Setting Professional Modifier None Typical Low $1,258.93 Median $1,621.81 Typical High $1,621.81 | Professional | None | $1,258.93 | $1,621.81 | $1,621.81 |
Medcost Setting Facility Modifier None Typical Low $1,258.93 Median $1,412.54 Typical High $2,041.74 | Facility | None | $1,258.93 | $1,412.54 | $2,041.74 |
Medcost Setting Professional Modifier None Typical Low $1,202.26 Median $1,230.27 Typical High $1,949.84 | Professional | None | $1,202.26 | $1,230.27 | $1,949.84 |
Sentara Setting Facility Modifier None Typical Low $891.25 Median $1,778.28 Typical High $6,165.95 | Facility | None | $891.25 | $1,778.28 | $6,165.95 |
Sentara Setting Professional Modifier None Typical Low $933.25 Median $1,230.27 Typical High $1,778.28 | Professional | None | $933.25 | $1,230.27 | $1,778.28 |
United Setting Facility Modifier None Typical Low $436.52 Median $2,344.23 Typical High $6,309.57 | Facility | None | $436.52 | $2,344.23 | $6,309.57 |
United Setting Professional Modifier None Typical Low $812.83 Median $1,047.13 Typical High $1,819.70 | Professional | None | $812.83 | $1,047.13 | $1,819.70 |
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 $630.96 Median $630.96 Typical High $645.65 | Professional | 52 · Reduced service | $630.96 | $630.96 | $645.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $251.19 Typical High $263.03 | Professional | 53 · Discontinued | $251.19 | $251.19 | $263.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $933.25 Typical High $977.24 | Professional | 54 · Surgery only | $933.25 | $933.25 | $977.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $186.21 Typical High $194.98 | Professional | 55 · Aftercare only | $186.21 | $186.21 | $194.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $125.89 Typical High $128.82 | Professional | 56 · Pre-op care only | $125.89 | $125.89 | $128.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $870.96 Typical High $912.01 | Professional | 78 · Unplanned return to OR | $870.96 | $870.96 | $912.01 |
Where Virginia 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.