How much rates vary
Facilitymedian $14,791 · 10th to 90th $776 to $15,136Professionalmedian $1,698 · 10th to 90th $1,230 to $2,399
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 Professional Modifier None Typical Low $1,412.54 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,412.54 | $1,412.54 | $1,412.54 |
Anthem BCBS Setting Facility Modifier None Typical Low $11,748.98 Median $14,791.08 Typical High $15,488.17 | Facility | None | $11,748.98 | $14,791.08 | $15,488.17 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,230.27 Median $1,819.70 Typical High $2,398.83 | Professional | None | $1,230.27 | $1,819.70 | $2,398.83 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $776.25 Median $1,148.15 Typical High $1,513.56 | Professional | 62 · Two surgeons | $776.25 | $1,148.15 | $1,513.56 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $194.98 Median $288.40 Typical High $389.05 | Professional | 80 · Assistant surgeon | $194.98 | $288.40 | $389.05 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $169.82 Median $251.19 Typical High $338.84 | Professional | AS · PA/NP assist | $169.82 | $251.19 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $707.95 Typical High $2,290.87 | Facility | None | $151.36 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,513.56 Median $1,548.82 Typical High $2,691.53 | Professional | None | $1,513.56 | $1,548.82 | $2,691.53 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,380.38 Median $1,819.70 Typical High $2,344.23 | Professional | None | $1,380.38 | $1,819.70 | $2,344.23 |
Martin's Point Setting Professional Modifier None Typical Low $1,230.27 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,230.27 | $1,412.54 | $1,412.54 |
United Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $1,318.26 Median $1,862.09 Typical High $2,398.83 | Professional | None | $1,318.26 | $1,862.09 | $2,398.83 |
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 $707.95 Median $707.95 Typical High $707.95 | Professional | 52 · Reduced service | $707.95 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | 53 · Discontinued | $281.84 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,047.13 Median $1,047.13 Typical High $1,047.13 | Professional | 54 · Surgery only | $1,047.13 | $1,047.13 | $1,047.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $213.80 Typical High $213.80 | Professional | 55 · Aftercare only | $213.80 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | 56 · Pre-op care only | $141.25 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $977.24 Median $977.24 Typical High $977.24 | Professional | 78 · Unplanned return to OR | $977.24 | $977.24 | $977.24 |
Where Maine sits
The same service costs 8.5 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 $16,489MD $1,943
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.