How much rates vary
Facilitymedian $4,074 · 10th to 90th $501 to $12,589Professionalmedian $1,413 · 10th to 90th $155 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 $3,715.35 Median $5,370.32 Typical High $12,589.25 | Facility | None | $3,715.35 | $5,370.32 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $1,584.89 Median $1,584.89 Typical High $4,265.80 | Professional | None | $1,584.89 | $1,584.89 | $4,265.80 |
Ambetter Setting Professional Modifier None Typical Low $1,445.44 Median $1,445.44 Typical High $1,445.44 | Professional | None | $1,445.44 | $1,445.44 | $1,445.44 |
Anthem BCBS Setting Facility Modifier None Typical Low $891.25 Median $6,606.93 Typical High $13,803.84 | Facility | None | $891.25 | $6,606.93 | $13,803.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,047.13 Median $1,445.44 Typical High $2,041.74 | Professional | None | $1,047.13 | $1,445.44 | $2,041.74 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $169.82 Median $234.42 Typical High $323.59 | Professional | 80 · Assistant surgeon | $169.82 | $234.42 | $323.59 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $147.91 Median $204.17 Typical High $288.40 | Professional | AS · PA/NP assist | $147.91 | $204.17 | $288.40 |
CareSource Setting Facility Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $1,949.84 | Facility | None | $1,949.84 | $1,949.84 | $1,949.84 |
CareSource Setting Professional Modifier None Typical Low $1,659.59 Median $1,659.59 Typical High $1,905.46 | Professional | None | $1,659.59 | $1,659.59 | $1,905.46 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,691.53 | Facility | None | $426.58 | $588.84 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,513.56 Median $1,698.24 Typical High $2,691.53 | Professional | None | $1,513.56 | $1,698.24 | $2,691.53 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $2,691.53 | Facility | None | $426.58 | $602.56 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1,513.56 Median $1,698.24 Typical High $2,691.53 | Professional | None | $1,513.56 | $1,698.24 | $2,691.53 |
Molina Setting Professional Modifier None Typical Low $134.90 Median $1,148.15 Typical High $1,905.46 | Professional | None | $134.90 | $1,148.15 | $1,905.46 |
SummaCare Setting Professional Modifier None Typical Low $1,513.56 Median $1,513.56 Typical High $1,778.28 | Professional | None | $1,513.56 | $1,513.56 | $1,778.28 |
United Setting Facility Modifier None Typical Low $371.54 Median $977.24 Typical High $4,677.35 | Facility | None | $371.54 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $1,288.25 Median $1,659.59 Typical High $2,570.40 | Professional | None | $1,288.25 | $1,659.59 | $2,570.40 |
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 $794.33 Median $794.33 Typical High $1,047.13 | Professional | 52 · Reduced service | $794.33 | $794.33 | $1,047.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $316.23 Typical High $416.87 | Professional | 53 · Discontinued | $316.23 | $316.23 | $416.87 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,202.26 Typical High $1,584.89 | Professional | 54 · Surgery only | $1,202.26 | $1,202.26 | $1,584.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $239.88 Typical High $316.23 | Professional | 55 · Aftercare only | $239.88 | $239.88 | $316.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $158.49 Typical High $208.93 | Professional | 56 · Pre-op care only | $158.49 | $158.49 | $208.93 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,122.02 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,122.02 | $1,479.11 |
Where Ohio 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.