How much rates vary
Facilitymedian $1,862 · 10th to 90th $457 to $9,550Professionalmedian $1,349 · 10th to 90th $1,047 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 $1,288.25 Median $1,412.54 Typical High $1,584.89 | Facility | None | $1,288.25 | $1,412.54 | $1,584.89 |
Aetna Setting Professional Modifier None Typical Low $1,230.27 Median $1,288.25 Typical High $1,659.59 | Professional | None | $1,230.27 | $1,288.25 | $1,659.59 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,467.37 Median $5,888.44 Typical High $11,220.18 | Facility | None | $3,467.37 | $5,888.44 | $11,220.18 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,047.13 Median $1,348.96 Typical High $1,737.80 | Professional | None | $1,047.13 | $1,348.96 | $1,737.80 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $660.69 Median $851.14 Typical High $1,096.48 | Professional | 62 · Two surgeons | $660.69 | $851.14 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $165.96 Median $213.80 Typical High $281.84 | Professional | 80 · Assistant surgeon | $165.96 | $213.80 | $281.84 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $147.91 Median $186.21 Typical High $245.47 | Professional | AS · PA/NP assist | $147.91 | $186.21 | $245.47 |
CareSource Setting Facility Modifier None Typical Low $977.24 Median $1,174.90 Typical High $1,862.09 | Facility | None | $977.24 | $1,174.90 | $1,862.09 |
CareSource Setting Professional Modifier None Typical Low $1,122.02 Median $1,621.81 Typical High $1,905.46 | Professional | None | $1,122.02 | $1,621.81 | $1,905.46 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $691.83 Typical High $1,995.26 | Facility | None | $34.67 | $691.83 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $1,174.90 Median $1,819.70 Typical High $10,964.78 | Professional | None | $1,174.90 | $1,819.70 | $10,964.78 |
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 $1,122.02 Median $1,659.59 Typical High $2,290.87 | Professional | None | $1,122.02 | $1,659.59 | $2,290.87 |
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 $616.60 Median $645.65 Typical High $831.76 | Professional | 52 · Reduced service | $616.60 | $645.65 | $831.76 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $245.47 Median $257.04 Typical High $331.13 | Professional | 53 · Discontinued | $245.47 | $257.04 | $331.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $954.99 Typical High $1,230.27 | Professional | 54 · Surgery only | $912.01 | $954.99 | $1,230.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $194.98 Typical High $245.47 | Professional | 55 · Aftercare only | $186.21 | $194.98 | $245.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $123.03 Median $128.82 Typical High $165.96 | Professional | 56 · Pre-op care only | $123.03 | $128.82 | $165.96 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $891.25 Typical High $1,148.15 | Professional | 78 · Unplanned return to OR | $851.14 | $891.25 | $1,148.15 |
Where Kentucky sits
The same service costs 9.0 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 $17,266MD $1,911
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.