How much rates vary
Facilitymedian $3,715 · 10th to 90th $501 to $16,596Professionalmedian $2,042 · 10th to 90th $174 to $3,162
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 $2,187.76 Median $10,232.93 Typical High $13,803.84 | Facility | None | $2,187.76 | $10,232.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $2,187.76 Median $2,187.76 Typical High $9,332.54 | Professional | None | $2,187.76 | $2,187.76 | $9,332.54 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,047.13 Median $7,943.28 Typical High $19,952.62 | Facility | None | $1,047.13 | $7,943.28 | $19,952.62 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,698.24 Median $2,187.76 Typical High $3,630.78 | Professional | None | $1,698.24 | $2,187.76 | $3,630.78 |
CareSource Setting Facility Modifier None Typical Low $2,691.53 Median $2,691.53 Typical High $2,691.53 | Facility | None | $2,691.53 | $2,691.53 | $2,691.53 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $2,691.53 | Facility | None | $426.58 | $602.56 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,905.46 Median $2,398.83 Typical High $4,466.84 | Professional | None | $1,905.46 | $2,398.83 | $4,466.84 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $426.58 Median $602.56 Typical High $2,691.53 | Facility | None | $426.58 | $602.56 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $1,905.46 Median $2,398.83 Typical High $4,466.84 | Professional | None | $1,905.46 | $2,398.83 | $4,466.84 |
Molina Setting Professional Modifier None Typical Low $162.18 Median $1,819.70 Typical High $2,754.23 | Professional | None | $162.18 | $1,819.70 | $2,754.23 |
SummaCare Setting Professional Modifier None Typical Low $1,995.26 Median $1,995.26 Typical High $3,162.28 | Professional | None | $1,995.26 | $1,995.26 | $3,162.28 |
United Setting Facility Modifier None Typical Low $371.54 Median $977.24 Typical High $4,677.35 | Facility | None | $371.54 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $2,041.74 Median $2,511.89 Typical High $5,248.07 | Professional | None | $2,041.74 | $2,511.89 | $5,248.07 |
9 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 $1,096.48 Median $1,096.48 Typical High $4,168.69 | Professional | 52 · Reduced service | $1,096.48 | $1,096.48 | $4,168.69 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $436.52 Median $436.52 Typical High $1,698.24 | Professional | 53 · Discontinued | $436.52 | $436.52 | $1,698.24 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,621.81 Median $1,621.81 Typical High $6,309.57 | Professional | 54 · Surgery only | $1,621.81 | $1,621.81 | $6,309.57 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $323.59 Median $323.59 Typical High $1,258.93 | Professional | 55 · Aftercare only | $323.59 | $323.59 | $1,258.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $218.78 Median $218.78 Typical High $851.14 | Professional | 56 · Pre-op care only | $218.78 | $218.78 | $851.14 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,513.56 Median $1,513.56 Typical High $5,888.44 | Professional | 78 · Unplanned return to OR | $1,513.56 | $1,513.56 | $5,888.44 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,071.52 Median $1,380.38 Typical High $2,290.87 | Professional | 62 · Two surgeons | $1,071.52 | $1,380.38 | $2,290.87 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $275.42 Median $354.81 Typical High $602.56 | Professional | 80 · Assistant surgeon | $275.42 | $354.81 | $602.56 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $239.88 Median $309.03 Typical High $512.86 | Professional | AS · PA/NP assist | $239.88 | $309.03 | $512.86 |
Where Ohio sits
The same service costs 9.8 times more in Maine than in Washington. 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 $25,999WA $2,645
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.