How much rates vary
Facilitymedian $3,981 · 10th to 90th $513 to $19,055Professionalmedian $1,318 · 10th to 90th $138 to $1,950
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 $2,454.71 Median $4,570.88 Typical High $12,589.25 | Facility | None | $2,454.71 | $4,570.88 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $1,318.26 Median $1,380.38 Typical High $5,011.87 | Professional | None | $1,318.26 | $1,380.38 | $5,011.87 |
Ambetter Setting Professional Modifier None Typical Low $1,096.48 Median $1,174.90 Typical High $1,621.81 | Professional | None | $1,096.48 | $1,174.90 | $1,621.81 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,148.15 Median $9,549.93 Typical High $22,908.68 | Facility | None | $1,148.15 | $9,549.93 | $22,908.68 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,071.52 Median $1,258.93 Typical High $2,041.74 | Professional | None | $1,071.52 | $1,258.93 | $2,041.74 |
CareSource Setting Facility Modifier None Typical Low $1,621.81 Median $1,621.81 Typical High $1,621.81 | Facility | None | $1,621.81 | $1,621.81 | $1,621.81 |
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 $1,174.90 Median $1,479.11 Typical High $2,691.53 | Professional | None | $1,174.90 | $1,479.11 | $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 $1,174.90 Median $1,479.11 Typical High $2,691.53 | Professional | None | $1,174.90 | $1,479.11 | $2,691.53 |
Molina Setting Professional Modifier None Typical Low $123.03 Median $1,258.93 Typical High $1,737.80 | Professional | None | $123.03 | $1,258.93 | $1,737.80 |
SummaCare Setting Professional Modifier None Typical Low $1,230.27 Median $1,230.27 Typical High $1,905.46 | Professional | None | $1,230.27 | $1,230.27 | $1,905.46 |
United Setting Facility Modifier None Typical Low $371.54 Median $977.24 Typical High $5,248.07 | Facility | None | $371.54 | $977.24 | $5,248.07 |
United Setting Professional Modifier None Typical Low $1,258.93 Median $1,548.82 Typical High $3,162.28 | Professional | None | $1,258.93 | $1,548.82 | $3,162.28 |
10 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 $660.69 Typical High $1,659.59 | Professional | 52 · Reduced service | $660.69 | $660.69 | $1,659.59 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $263.03 Typical High $660.69 | Professional | 53 · Discontinued | $263.03 | $263.03 | $660.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,000.00 Typical High $2,511.89 | Professional | 54 · Surgery only | $1,000.00 | $1,000.00 | $2,511.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $199.53 Typical High $501.19 | Professional | 55 · Aftercare only | $199.53 | $199.53 | $501.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $131.83 Typical High $331.13 | Professional | 56 · Pre-op care only | $131.83 | $131.83 | $331.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $933.25 Typical High $2,344.23 | Professional | 78 · Unplanned return to OR | $933.25 | $933.25 | $2,344.23 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,584.89 Median $1,862.09 Typical High $3,019.95 | Professional | 50 · Both sides | $1,584.89 | $1,862.09 | $3,019.95 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $660.69 Median $776.25 Typical High $1,288.25 | Professional | 62 · Two surgeons | $660.69 | $776.25 | $1,288.25 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $169.82 Median $199.53 Typical High $331.13 | Professional | 80 · Assistant surgeon | $169.82 | $199.53 | $331.13 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $147.91 Median $173.78 Typical High $288.40 | Professional | AS · PA/NP assist | $147.91 | $173.78 | $288.40 |
Where Ohio 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.