How much rates vary
Facilitymedian $6,310 · 10th to 90th $891 to $13,490Professionalmedian $1,230 · 10th to 90th $741 to $1,862
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 $4,365.16 Median $5,754.40 Typical High $8,511.38 | Facility | None | $4,365.16 | $5,754.40 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $870.96 Median $1,445.44 Typical High $1,445.44 | Professional | None | $870.96 | $1,445.44 | $1,445.44 |
Anthem BCBS Setting Facility Modifier None Typical Low $3,981.07 Median $11,748.98 Typical High $13,803.84 | Facility | None | $3,981.07 | $11,748.98 | $13,803.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $724.44 Median $1,174.90 Typical High $1,737.80 | Professional | None | $724.44 | $1,174.90 | $1,737.80 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $457.09 Median $741.31 Typical High $1,096.48 | Professional | 62 · Two surgeons | $457.09 | $741.31 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $117.49 Median $190.55 Typical High $281.84 | Professional | 80 · Assistant surgeon | $117.49 | $190.55 | $281.84 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $102.33 Median $165.96 Typical High $245.47 | Professional | AS · PA/NP assist | $102.33 | $165.96 | $245.47 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,000.00 Typical High $27,542.29 | Facility | None | $501.19 | $1,000.00 | $27,542.29 |
Cigna Setting Professional Modifier None Typical Low $1,000.00 Median $1,230.27 Typical High $1,949.84 | Professional | None | $1,000.00 | $1,230.27 | $1,949.84 |
ConnectiCare Setting Professional Modifier None Typical Low $1,288.25 Median $1,288.25 Typical High $1,380.38 | Professional | None | $1,288.25 | $1,288.25 | $1,380.38 |
United Setting Facility Modifier None Typical Low $870.96 Median $5,495.41 Typical High $9,772.37 | Facility | None | $870.96 | $5,495.41 | $9,772.37 |
United Setting Professional Modifier None Typical Low $741.31 Median $1,023.29 Typical High $2,454.71 | Professional | None | $741.31 | $1,023.29 | $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 $436.52 Median $724.44 Typical High $724.44 | Professional | 52 · Reduced service | $436.52 | $724.44 | $724.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $173.78 Median $288.40 Typical High $288.40 | Professional | 53 · Discontinued | $173.78 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $660.69 Median $1,071.52 Typical High $1,071.52 | Professional | 54 · Surgery only | $660.69 | $1,071.52 | $1,071.52 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $131.83 Median $213.80 Typical High $213.80 | Professional | 55 · Aftercare only | $131.83 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $87.10 Median $144.54 Typical High $144.54 | Professional | 56 · Pre-op care only | $87.10 | $144.54 | $144.54 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $616.60 Median $1,000.00 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $616.60 | $1,000.00 | $1,000.00 |
Where Connecticut sits
The same service costs 7.8 times more in Maine than in Massachusetts. 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 $16,585MA $2,122
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.