How much rates vary
Facilitymedian $1,479 · 10th to 90th $692 to $8,913Professionalmedian $832 · 10th to 90th $661 to $1,318
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 $794.33 Median $912.01 Typical High $977.24 | Facility | None | $794.33 | $912.01 | $977.24 |
Aetna Setting Professional Modifier None Typical Low $758.58 Median $794.33 Typical High $1,023.29 | Professional | None | $758.58 | $794.33 | $1,023.29 |
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 $660.69 Median $831.76 Typical High $1,122.02 | Professional | None | $660.69 | $831.76 | $1,122.02 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $416.87 Median $524.81 Typical High $707.95 | Professional | 62 · Two surgeons | $416.87 | $524.81 | $707.95 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $107.15 Median $131.83 Typical High $177.83 | Professional | 80 · Assistant surgeon | $107.15 | $131.83 | $177.83 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $93.33 Median $114.82 Typical High $158.49 | Professional | AS · PA/NP assist | $93.33 | $114.82 | $158.49 |
CareSource Setting Facility Modifier None Typical Low $602.56 Median $724.44 Typical High $1,148.15 | Facility | None | $602.56 | $724.44 | $1,148.15 |
CareSource Setting Professional Modifier None Typical Low $645.65 Median $1,000.00 Typical High $1,174.90 | Professional | None | $645.65 | $1,000.00 | $1,174.90 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $691.83 Typical High $1,230.27 | Facility | None | $34.67 | $691.83 | $1,230.27 |
Cigna Setting Professional Modifier None Typical Low $724.44 Median $1,122.02 Typical High $4,786.30 | Professional | None | $724.44 | $1,122.02 | $4,786.30 |
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 $741.31 Median $1,479.11 Typical High $5,128.61 | Facility | None | $741.31 | $1,479.11 | $5,128.61 |
United Setting Professional Modifier None Typical Low $707.95 Median $1,023.29 Typical High $1,380.38 | Professional | None | $707.95 | $1,023.29 | $1,380.38 |
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 $380.19 Median $398.11 Typical High $501.19 | Professional | 52 · Reduced service | $380.19 | $398.11 | $501.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $151.36 Median $158.49 Typical High $204.17 | Professional | 53 · Discontinued | $151.36 | $158.49 | $204.17 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $562.34 Median $588.84 Typical High $758.58 | Professional | 54 · Surgery only | $562.34 | $588.84 | $758.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $112.20 Median $117.49 Typical High $151.36 | Professional | 55 · Aftercare only | $112.20 | $117.49 | $151.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $79.43 Typical High $102.33 | Professional | 56 · Pre-op care only | $75.86 | $79.43 | $102.33 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $524.81 Median $549.54 Typical High $707.95 | Professional | 78 · Unplanned return to OR | $524.81 | $549.54 | $707.95 |
Where Kentucky 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.