How much rates vary
Facilitymedian $3,631 · 10th to 90th $776 to $16,218Professionalmedian $1,660 · 10th to 90th $1,000 to $2,570
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 $954.99 Median $1,000.00 Typical High $1,174.90 | Professional | None | $954.99 | $1,000.00 | $1,174.90 |
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 $1,023.29 Median $1,737.80 Typical High $2,398.83 | Professional | None | $1,023.29 | $1,737.80 | $2,398.83 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $630.96 Median $1,071.52 Typical High $1,445.44 | Professional | 62 · Two surgeons | $630.96 | $1,071.52 | $1,445.44 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $162.18 Median $269.15 Typical High $371.54 | Professional | 80 · Assistant surgeon | $162.18 | $269.15 | $371.54 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $141.25 Median $239.88 Typical High $323.59 | Professional | AS · PA/NP assist | $141.25 | $239.88 | $323.59 |
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 $1,096.48 Median $1,862.09 Typical High $2,630.27 | Professional | None | $1,096.48 | $1,862.09 | $2,630.27 |
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 $1,047.13 Median $1,412.54 Typical High $2,754.23 | Professional | None | $1,047.13 | $1,412.54 | $2,754.23 |
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 $1,047.13 Median $1,380.38 Typical High $2,754.23 | Professional | None | $1,047.13 | $1,380.38 | $2,754.23 |
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 $478.63 Median $501.19 Typical High $588.84 | Professional | 52 · Reduced service | $478.63 | $501.19 | $588.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $190.55 Median $199.53 Typical High $234.42 | Professional | 53 · Discontinued | $190.55 | $199.53 | $234.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $724.44 Median $758.58 Typical High $870.96 | Professional | 54 · Surgery only | $724.44 | $758.58 | $870.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $144.54 Median $151.36 Typical High $173.78 | Professional | 55 · Aftercare only | $144.54 | $151.36 | $173.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $95.50 Median $100.00 Typical High $117.49 | Professional | 56 · Pre-op care only | $95.50 | $100.00 | $117.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $676.08 Median $707.95 Typical High $812.83 | Professional | 78 · Unplanned return to OR | $676.08 | $707.95 | $812.83 |
Where New Hampshire sits
The same service costs 10.6 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 $17,137MD $1,609
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.