How much rates vary
Facilitymedian $2,138 · 10th to 90th $479 to $6,310Professionalmedian $1,096 · 10th to 90th $776 to $2,188
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 $891.25 Median $4,897.79 Typical High $7,762.47 | Facility | None | $891.25 | $4,897.79 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $707.95 Median $891.25 Typical High $1,023.29 | Professional | None | $707.95 | $891.25 | $1,023.29 |
Anthem BCBS Setting Facility Modifier None Typical Low $446.68 Median $1,778.28 Typical High $5,623.41 | Facility | None | $446.68 | $1,778.28 | $5,623.41 |
Anthem BCBS Setting Professional Modifier None Typical Low $812.83 Median $1,047.13 Typical High $1,513.56 | Professional | None | $812.83 | $1,047.13 | $1,513.56 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $512.86 Median $660.69 Typical High $954.99 | Professional | 62 · Two surgeons | $512.86 | $660.69 | $954.99 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $131.83 Median $169.82 Typical High $239.88 | Professional | 80 · Assistant surgeon | $131.83 | $169.82 | $239.88 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $114.82 Median $154.88 Typical High $213.80 | Professional | AS · PA/NP assist | $114.82 | $154.88 | $213.80 |
BCBS Kansas City Setting Professional Modifier None Typical Low $707.95 Median $776.25 Typical High $1,096.48 | Professional | None | $707.95 | $776.25 | $1,096.48 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $691.83 Typical High $2,691.53 | Facility | None | $489.78 | $691.83 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $776.25 Median $912.01 Typical High $1,737.80 | Professional | None | $776.25 | $912.01 | $1,737.80 |
Medica Setting Facility Modifier None Typical Low $54.95 Median $2,187.76 Typical High $6,309.57 | Facility | None | $54.95 | $2,187.76 | $6,309.57 |
Medica Setting Professional Modifier None Typical Low $933.25 Median $1,737.80 Typical High $9,772.37 | Professional | None | $933.25 | $1,737.80 | $9,772.37 |
United Setting Facility Modifier None Typical Low $1,000.00 Median $3,467.37 Typical High $6,760.83 | Facility | None | $1,000.00 | $3,467.37 | $6,760.83 |
United Setting Professional Modifier None Typical Low $812.83 Median $1,174.90 Typical High $2,041.74 | Professional | None | $812.83 | $1,174.90 | $2,041.74 |
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 $354.81 Median $436.52 Typical High $457.09 | Professional | 52 · Reduced service | $354.81 | $436.52 | $457.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $141.25 Median $177.83 Typical High $181.97 | Professional | 53 · Discontinued | $141.25 | $177.83 | $181.97 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $524.81 Median $660.69 Typical High $676.08 | Professional | 54 · Surgery only | $524.81 | $660.69 | $676.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $104.71 Median $131.83 Typical High $134.90 | Professional | 55 · Aftercare only | $104.71 | $131.83 | $134.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $70.79 Median $89.13 Typical High $91.20 | Professional | 56 · Pre-op care only | $70.79 | $89.13 | $91.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $489.78 Median $616.60 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $489.78 | $616.60 | $630.96 |
Where Missouri 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.