How much rates vary
Facilitymedian $1,995 · 10th to 90th $457 to $11,220Professionalmedian $1,445 · 10th to 90th $1,122 to $2,239
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 $1,380.38 Median $1,548.82 Typical High $2,398.83 | Facility | None | $1,380.38 | $1,548.82 | $2,398.83 |
Aetna Setting Professional Modifier None Typical Low $1,318.26 Median $1,380.38 Typical High $2,398.83 | Professional | None | $1,318.26 | $1,380.38 | $2,398.83 |
Ambetter Setting Professional Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,230.27 | Professional | None | $1,230.27 | $1,230.27 | $1,230.27 |
Anthem BCBS Setting Facility Modifier None Typical Low $5,888.44 Median $10,000.00 Typical High $16,218.10 | Facility | None | $5,888.44 | $10,000.00 | $16,218.10 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,122.02 Median $1,445.44 Typical High $1,862.09 | Professional | None | $1,122.02 | $1,445.44 | $1,862.09 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,698.24 Median $2,187.76 Typical High $2,818.38 | Professional | 50 · Both sides | $1,698.24 | $2,187.76 | $2,818.38 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $707.95 Median $912.01 Typical High $1,174.90 | Professional | 62 · Two surgeons | $707.95 | $912.01 | $1,174.90 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $177.83 Median $234.42 Typical High $295.12 | Professional | 80 · Assistant surgeon | $177.83 | $234.42 | $295.12 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $158.49 Median $204.17 Typical High $263.03 | Professional | AS · PA/NP assist | $158.49 | $204.17 | $263.03 |
CareSource Setting Facility Modifier None Typical Low $1,047.13 Median $1,258.93 Typical High $1,995.26 | Facility | None | $1,047.13 | $1,258.93 | $1,995.26 |
CareSource Setting Professional Modifier None Typical Low $1,122.02 Median $1,737.80 Typical High $2,041.74 | Professional | None | $1,122.02 | $1,737.80 | $2,041.74 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $512.86 Typical High $2,089.30 | Facility | None | $34.67 | $512.86 | $2,089.30 |
Cigna Setting Professional Modifier None Typical Low $1,258.93 Median $1,995.26 Typical High $8,128.31 | Professional | None | $1,258.93 | $1,995.26 | $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 $1,230.27 Median $1,778.28 Typical High $2,454.71 | Professional | None | $1,230.27 | $1,778.28 | $2,454.71 |
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 $660.69 Median $691.83 Typical High $870.96 | Professional | 52 · Reduced service | $660.69 | $691.83 | $870.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $275.42 Typical High $346.74 | Professional | 53 · Discontinued | $263.03 | $275.42 | $346.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $977.24 Median $1,023.29 Typical High $1,318.26 | Professional | 54 · Surgery only | $977.24 | $1,023.29 | $1,318.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $194.98 Median $204.17 Typical High $263.03 | Professional | 55 · Aftercare only | $194.98 | $204.17 | $263.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $138.04 Typical High $173.78 | Professional | 56 · Pre-op care only | $131.83 | $138.04 | $173.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $954.99 Typical High $1,230.27 | Professional | 78 · Unplanned return to OR | $912.01 | $954.99 | $1,230.27 |
Where Kentucky sits
The same service costs 14.0 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 $28,122MD $2,008
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.