How much rates vary
Facilitymedian $3,631 · 10th to 90th $776 to $16,218Professionalmedian $2,512 · 10th to 90th $1,585 to $3,981
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 $2,398.83 Median $2,398.83 Typical High $9,772.37 | Facility | None | $2,398.83 | $2,398.83 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $1,513.56 Median $1,584.89 Typical High $1,862.09 | Professional | None | $1,513.56 | $1,584.89 | $1,862.09 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,890.45 Median $10,000.00 Typical High $16,982.44 | Facility | None | $3,890.45 | $10,000.00 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,737.80 Median $2,754.23 Typical High $3,630.78 | Professional | None | $1,737.80 | $2,754.23 | $3,630.78 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $288.40 Median $416.87 Typical High $562.34 | Professional | 80 · Assistant surgeon | $288.40 | $416.87 | $562.34 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $257.04 Median $363.08 Typical High $489.78 | Professional | AS · PA/NP assist | $257.04 | $363.08 | $489.78 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $630.96 Typical High $2,691.53 | Facility | None | $489.78 | $630.96 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,698.24 Median $2,951.21 Typical High $4,168.69 | Professional | None | $1,698.24 | $2,951.21 | $4,168.69 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $851.14 Typical High $2,884.03 | Facility | None | $776.25 | $851.14 | $2,884.03 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,621.81 Median $2,238.72 Typical High $4,365.16 | Professional | None | $1,621.81 | $2,238.72 | $4,365.16 |
United Setting Facility Modifier None Typical Low $776.25 Median $933.25 Typical High $2,884.03 | Facility | None | $776.25 | $933.25 | $2,884.03 |
United Setting Professional Modifier None Typical Low $1,659.59 Median $2,187.76 Typical High $4,365.16 | Professional | None | $1,659.59 | $2,187.76 | $4,365.16 |
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 $758.58 Median $794.33 Typical High $933.25 | Professional | 52 · Reduced service | $758.58 | $794.33 | $933.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $302.00 Median $323.59 Typical High $371.54 | Professional | 53 · Discontinued | $302.00 | $323.59 | $371.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $1,202.26 Typical High $1,380.38 | Professional | 54 · Surgery only | $1,148.15 | $1,202.26 | $1,380.38 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $239.88 Typical High $275.42 | Professional | 55 · Aftercare only | $229.09 | $239.88 | $275.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $151.36 Median $158.49 Typical High $186.21 | Professional | 56 · Pre-op care only | $151.36 | $158.49 | $186.21 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,122.02 Typical High $1,288.25 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,122.02 | $1,288.25 |
Where New Hampshire 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.