How much rates vary
Facilitymedian $1,995 · 10th to 90th $457 to $11,220Professionalmedian $1,479 · 10th to 90th $1,148 to $2,344
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 $1,412.54 Median $1,659.59 Typical High $1,737.80 | Facility | None | $1,412.54 | $1,659.59 | $1,737.80 |
Aetna Setting Professional Modifier None Typical Low $1,348.96 Median $1,412.54 Typical High $1,819.70 | Professional | None | $1,348.96 | $1,412.54 | $1,819.70 |
Anthem BCBS Setting Facility Modifier None Typical Low $5,128.61 Median $8,709.64 Typical High $14,125.38 | Facility | None | $5,128.61 | $8,709.64 | $14,125.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,148.15 Median $1,479.11 Typical High $2,089.30 | Professional | None | $1,148.15 | $1,479.11 | $2,089.30 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $724.44 Median $933.25 Typical High $1,318.26 | Professional | 62 · Two surgeons | $724.44 | $933.25 | $1,318.26 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $186.21 Median $239.88 Typical High $331.13 | Professional | 80 · Assistant surgeon | $186.21 | $239.88 | $331.13 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $162.18 Median $208.93 Typical High $295.12 | Professional | AS · PA/NP assist | $162.18 | $208.93 | $295.12 |
CareSource Setting Facility Modifier None Typical Low $1,096.48 Median $1,318.26 Typical High $2,041.74 | Facility | None | $1,096.48 | $1,318.26 | $2,041.74 |
CareSource Setting Professional Modifier None Typical Low $1,174.90 Median $1,778.28 Typical High $2,089.30 | Professional | None | $1,174.90 | $1,778.28 | $2,089.30 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $691.83 Typical High $2,187.76 | Facility | None | $34.67 | $691.83 | $2,187.76 |
Cigna Setting Professional Modifier None Typical Low $1,318.26 Median $2,041.74 Typical High $12,882.50 | Professional | None | $1,318.26 | $2,041.74 | $12,882.50 |
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 $1,258.93 Median $1,819.70 Typical High $2,511.89 | Professional | None | $1,258.93 | $1,819.70 | $2,511.89 |
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 $676.08 Median $707.95 Typical High $912.01 | Professional | 52 · Reduced service | $676.08 | $707.95 | $912.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $281.84 Typical High $363.08 | Professional | 53 · Discontinued | $269.15 | $281.84 | $363.08 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,071.52 Typical High $1,348.96 | Professional | 54 · Surgery only | $1,023.29 | $1,071.52 | $1,348.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $213.80 Typical High $275.42 | Professional | 55 · Aftercare only | $204.17 | $213.80 | $275.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $141.25 Typical High $181.97 | Professional | 56 · Pre-op care only | $134.90 | $141.25 | $181.97 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $1,000.00 Typical High $1,258.93 | Professional | 78 · Unplanned return to OR | $954.99 | $1,000.00 | $1,258.93 |
Where Kentucky sits
The same service costs 12.0 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 $24,859MD $2,076
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.