How much rates vary
Facilitymedian $1,995 · 10th to 90th $457 to $9,772Professionalmedian $1,318 · 10th to 90th $1,096 to $2,089
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 $1,548.82 Median $1,548.82 Typical High $1,949.84 | Facility | None | $1,548.82 | $1,548.82 | $1,949.84 |
Aetna Setting Professional Modifier None Typical Low $1,513.56 Median $1,584.89 Typical High $1,949.84 | Professional | None | $1,513.56 | $1,584.89 | $1,949.84 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,548.13 Median $6,025.60 Typical High $11,220.18 | Facility | None | $3,548.13 | $6,025.60 | $11,220.18 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,071.52 Median $1,258.93 Typical High $1,445.44 | Professional | None | $1,071.52 | $1,258.93 | $1,445.44 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $173.78 Median $204.17 Typical High $234.42 | Professional | 80 · Assistant surgeon | $173.78 | $204.17 | $234.42 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $151.36 Median $177.83 Typical High $204.17 | Professional | AS · PA/NP assist | $151.36 | $177.83 | $204.17 |
CareSource Setting Facility Modifier None Typical Low $1,258.93 Median $1,513.56 Typical High $2,344.23 | Facility | None | $1,258.93 | $1,513.56 | $2,344.23 |
CareSource Setting Professional Modifier None Typical Low $1,318.26 Median $1,862.09 Typical High $2,344.23 | Professional | None | $1,318.26 | $1,862.09 | $2,344.23 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $512.86 Typical High $2,630.27 | Facility | None | $34.67 | $512.86 | $2,630.27 |
Cigna Setting Professional Modifier None Typical Low $1,513.56 Median $1,737.80 Typical High $8,128.31 | Professional | None | $1,513.56 | $1,737.80 | $8,128.31 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
United Setting Facility Modifier None Typical Low $354.81 Median $912.01 Typical High $8,317.64 | Facility | None | $354.81 | $912.01 | $8,317.64 |
United Setting Professional Modifier None Typical Low $1,412.54 Median $1,949.84 Typical High $2,454.71 | Professional | None | $1,412.54 | $1,949.84 | $2,454.71 |
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 $776.25 Median $794.33 Typical High $977.24 | Professional | 52 · Reduced service | $776.25 | $794.33 | $977.24 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $316.23 Typical High $389.05 | Professional | 53 · Discontinued | $309.03 | $316.23 | $389.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,202.26 Typical High $1,479.11 | Professional | 54 · Surgery only | $1,174.90 | $1,202.26 | $1,479.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $239.88 Typical High $295.12 | Professional | 55 · Aftercare only | $234.42 | $239.88 | $295.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $158.49 Typical High $194.98 | Professional | 56 · Pre-op care only | $154.88 | $158.49 | $194.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,122.02 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,122.02 | $1,380.38 |
Ambetter Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,778.28 Median $1,778.28 Typical High $1,778.28 | Professional | 78 · Unplanned return to OR | $1,778.28 | $1,778.28 | $1,778.28 |
Where Kentucky 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.