How much rates vary
Facilitymedian $977 · 10th to 90th $501 to $6,761Professionalmedian $2,239 · 10th to 90th $1,479 to $4,169
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 $1,584.89 Median $5,370.32 Typical High $7,943.28 | Facility | None | $1,584.89 | $5,370.32 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $1,584.89 Median $1,778.28 Typical High $4,168.69 | Professional | None | $1,584.89 | $1,778.28 | $4,168.69 |
Ambetter Setting Professional Modifier None Typical Low $2,238.72 Median $2,238.72 Typical High $2,238.72 | Professional | None | $2,238.72 | $2,238.72 | $2,238.72 |
Anthem BCBS Setting Facility Modifier None Typical Low $588.84 Median $1,862.09 Typical High $8,128.31 | Facility | None | $588.84 | $1,862.09 | $8,128.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,318.26 Median $2,238.72 Typical High $3,801.89 | Professional | None | $1,318.26 | $2,238.72 | $3,801.89 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $263.03 Median $407.38 Typical High $645.65 | Professional | 80 · Assistant surgeon | $263.03 | $407.38 | $645.65 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $229.09 Median $309.03 Typical High $562.34 | Professional | AS · PA/NP assist | $229.09 | $309.03 | $562.34 |
CareSource Setting Professional Modifier None Typical Low $1,479.11 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,479.11 | $1,479.11 | $1,479.11 |
Cigna Setting Facility Modifier None Typical Low $446.68 Median $549.54 Typical High $2,511.89 | Facility | None | $446.68 | $549.54 | $2,511.89 |
Cigna Setting Professional Modifier None Typical Low $1,548.82 Median $2,511.89 Typical High $4,570.88 | Professional | None | $1,548.82 | $2,511.89 | $4,570.88 |
Kaiser Permanente Setting Professional Modifier None Typical Low $1,778.28 Median $2,041.74 Typical High $2,290.87 | Professional | None | $1,778.28 | $2,041.74 | $2,290.87 |
Oscar Health Setting Professional Modifier None Typical Low $1,584.89 Median $2,818.38 Typical High $3,715.35 | Professional | None | $1,584.89 | $2,818.38 | $3,715.35 |
United Setting Facility Modifier None Typical Low $371.54 Median $645.65 Typical High $3,981.07 | Facility | None | $371.54 | $645.65 | $3,981.07 |
United Setting Professional Modifier None Typical Low $1,445.44 Median $2,570.40 Typical High $5,128.61 | Professional | None | $1,445.44 | $2,570.40 | $5,128.61 |
7 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 $794.33 Median $794.33 Typical High $954.99 | Professional | 52 · Reduced service | $794.33 | $794.33 | $954.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $316.23 Typical High $380.19 | Professional | 53 · Discontinued | $316.23 | $316.23 | $380.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,202.26 Typical High $1,412.54 | Professional | 54 · Surgery only | $1,202.26 | $1,202.26 | $1,412.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $239.88 Typical High $288.40 | Professional | 55 · Aftercare only | $239.88 | $239.88 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $158.49 Typical High $190.55 | Professional | 56 · Pre-op care only | $158.49 | $158.49 | $190.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,122.02 Typical High $1,318.26 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,122.02 | $1,318.26 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $2,951.21 Median $2,951.21 Typical High $2,951.21 | Professional | 59 · Distinct service | $2,951.21 | $2,951.21 | $2,951.21 |
Where Georgia sits
The same service costs 8.1 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 $17,891MD $2,222
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.