How much rates vary
Facilitymedian $5,495 · 10th to 90th $1,148 to $19,953Professionalmedian $1,514 · 10th to 90th $1,230 to $2,399
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 $1,513.56 Median $7,762.47 Typical High $16,595.87 | Facility | None | $1,513.56 | $7,762.47 | $16,595.87 |
Aetna Setting Professional Modifier None Typical Low $1,412.54 Median $1,513.56 Typical High $2,884.03 | Professional | None | $1,412.54 | $1,513.56 | $2,884.03 |
Anthem BCBS Setting Facility Modifier None Typical Low $5,248.07 Median $12,589.25 Typical High $23,442.29 | Facility | None | $5,248.07 | $12,589.25 | $23,442.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,230.27 Median $1,479.11 Typical High $1,905.46 | Professional | None | $1,230.27 | $1,479.11 | $1,905.46 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,862.09 Median $2,238.72 Typical High $2,818.38 | Professional | 50 · Both sides | $1,862.09 | $2,238.72 | $2,818.38 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $776.25 Median $933.25 Typical High $1,202.26 | Professional | 62 · Two surgeons | $776.25 | $933.25 | $1,202.26 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $199.53 Median $234.42 Typical High $302.00 | Professional | 80 · Assistant surgeon | $199.53 | $234.42 | $302.00 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $173.78 Median $208.93 Typical High $263.03 | Professional | AS · PA/NP assist | $173.78 | $208.93 | $263.03 |
CareFirst Setting Professional Modifier None Typical Low $1,348.96 Median $1,479.11 Typical High $1,949.84 | Professional | None | $1,348.96 | $1,479.11 | $1,949.84 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,174.90 Typical High $5,495.41 | Facility | None | $501.19 | $1,174.90 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $1,288.25 Median $1,548.82 Typical High $2,290.87 | Professional | None | $1,288.25 | $1,548.82 | $2,290.87 |
Kaiser Permanente Setting Professional Modifier None Typical Low $1,148.15 Median $1,348.96 Typical High $1,698.24 | Professional | None | $1,148.15 | $1,348.96 | $1,698.24 |
Medcost Setting Professional Modifier None Typical Low $1,778.28 Median $2,238.72 Typical High $2,238.72 | Professional | None | $1,778.28 | $2,238.72 | $2,238.72 |
Medcost Setting Facility Modifier None Typical Low $1,513.56 Median $1,995.26 Typical High $2,511.89 | Facility | None | $1,513.56 | $1,995.26 | $2,511.89 |
Medcost Setting Professional Modifier None Typical Low $1,819.70 Median $1,819.70 Typical High $1,819.70 | Professional | None | $1,819.70 | $1,819.70 | $1,819.70 |
Sentara Setting Facility Modifier None Typical Low $1,047.13 Median $1,995.26 Typical High $7,413.10 | Facility | None | $1,047.13 | $1,995.26 | $7,413.10 |
Sentara Setting Professional Modifier None Typical Low $1,288.25 Median $1,778.28 Typical High $3,311.31 | Professional | None | $1,288.25 | $1,778.28 | $3,311.31 |
United Setting Facility Modifier None Typical Low $436.52 Median $2,344.23 Typical High $6,309.57 | Facility | None | $436.52 | $2,344.23 | $6,309.57 |
United Setting Professional Modifier None Typical Low $1,096.48 Median $1,778.28 Typical High $2,691.53 | Professional | None | $1,096.48 | $1,778.28 | $2,691.53 |
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 $707.95 Median $758.58 Typical High $758.58 | Professional | 52 · Reduced service | $707.95 | $758.58 | $758.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $281.84 Median $302.00 Typical High $302.00 | Professional | 53 · Discontinued | $281.84 | $302.00 | $302.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,047.13 Median $1,148.15 Typical High $1,148.15 | Professional | 54 · Surgery only | $1,047.13 | $1,148.15 | $1,148.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $208.93 Median $229.09 Typical High $229.09 | Professional | 55 · Aftercare only | $208.93 | $229.09 | $229.09 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $151.36 Typical High $151.36 | Professional | 56 · Pre-op care only | $141.25 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $977.24 Median $1,071.52 Typical High $1,071.52 | Professional | 78 · Unplanned return to OR | $977.24 | $1,071.52 | $1,071.52 |
Where Virginia 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.