How much rates vary
Facilitymedian $5,370 · 10th to 90th $1,047 to $20,417Professionalmedian $1,288 · 10th to 90th $1,047 to $1,950
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 $1,258.93 Median $5,495.41 Typical High $14,125.38 | Facility | None | $1,258.93 | $5,495.41 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $1,122.02 Median $1,258.93 Typical High $1,737.80 | Professional | None | $1,122.02 | $1,258.93 | $1,737.80 |
Anthem BCBS Setting Facility Modifier None Typical Low $5,248.07 Median $12,589.25 Typical High $23,988.33 | Facility | None | $5,248.07 | $12,589.25 | $23,988.33 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,047.13 Median $1,258.93 Typical High $1,584.89 | Professional | None | $1,047.13 | $1,258.93 | $1,584.89 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $660.69 Median $794.33 Typical High $1,000.00 | Professional | 62 · Two surgeons | $660.69 | $794.33 | $1,000.00 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $165.96 Median $199.53 Typical High $257.04 | Professional | 80 · Assistant surgeon | $165.96 | $199.53 | $257.04 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $144.54 Median $173.78 Typical High $223.87 | Professional | AS · PA/NP assist | $144.54 | $173.78 | $223.87 |
CareFirst Setting Professional Modifier None Typical Low $1,202.26 Median $1,318.26 Typical High $1,737.80 | Professional | None | $1,202.26 | $1,318.26 | $1,737.80 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,174.90 Typical High $5,495.41 | Facility | None | $501.19 | $1,174.90 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $1,071.52 Median $1,288.25 Typical High $1,949.84 | Professional | None | $1,071.52 | $1,288.25 | $1,949.84 |
Kaiser Permanente Setting Professional Modifier None Typical Low $1,023.29 Median $1,230.27 Typical High $1,513.56 | Professional | None | $1,023.29 | $1,230.27 | $1,513.56 |
Medcost Setting Professional Modifier None Typical Low $1,621.81 Median $2,041.74 Typical High $2,041.74 | Professional | None | $1,621.81 | $2,041.74 | $2,041.74 |
Medcost Setting Facility Modifier None Typical Low $1,258.93 Median $1,584.89 Typical High $2,041.74 | Facility | None | $1,258.93 | $1,584.89 | $2,041.74 |
Medcost Setting Professional Modifier None Typical Low $1,479.11 Median $1,479.11 Typical High $1,479.11 | Professional | None | $1,479.11 | $1,479.11 | $1,479.11 |
Sentara Setting Facility Modifier None Typical Low $933.25 Median $1,778.28 Typical High $7,413.10 | Facility | None | $933.25 | $1,778.28 | $7,413.10 |
Sentara Setting Professional Modifier None Typical Low $1,122.02 Median $1,513.56 Typical High $2,754.23 | Professional | None | $1,122.02 | $1,513.56 | $2,754.23 |
United Setting Facility Modifier None Typical Low $436.52 Median $2,344.23 Typical High $6,309.57 | Facility | None | $436.52 | $2,344.23 | $6,309.57 |
United Setting Professional Modifier None Typical Low $912.01 Median $1,513.56 Typical High $2,238.72 | Professional | None | $912.01 | $1,513.56 | $2,238.72 |
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 $549.54 Median $630.96 Typical High $630.96 | Professional | 52 · Reduced service | $549.54 | $630.96 | $630.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $251.19 Typical High $251.19 | Professional | 53 · Discontinued | $223.87 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $954.99 Typical High $954.99 | Professional | 54 · Surgery only | $831.76 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $190.55 Typical High $190.55 | Professional | 55 · Aftercare only | $165.96 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $125.89 Typical High $125.89 | Professional | 56 · Pre-op care only | $109.65 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $891.25 Typical High $891.25 | Professional | 78 · Unplanned return to OR | $776.25 | $891.25 | $891.25 |
Where Virginia sits
The same service costs 15.4 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 $28,500MD $1,851
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.