How much rates vary
Facilitymedian $4,074 · 10th to 90th $1,072 to $11,482Professionalmedian $1,413 · 10th to 90th $1,175 to $2,089
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 $5,495.41 Typical High $14,125.38 | Facility | None | $1,412.54 | $5,495.41 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $1,258.93 Median $1,412.54 Typical High $1,513.56 | Professional | None | $1,258.93 | $1,412.54 | $1,513.56 |
Anthem BCBS Setting Facility Modifier None Typical Low $2,884.03 Median $7,079.46 Typical High $12,882.50 | Facility | None | $2,884.03 | $7,079.46 | $12,882.50 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,174.90 Median $1,412.54 Typical High $1,819.70 | Professional | None | $1,174.90 | $1,412.54 | $1,819.70 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $741.31 Median $891.25 Typical High $1,148.15 | Professional | 62 · Two surgeons | $741.31 | $891.25 | $1,148.15 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $190.55 Median $223.87 Typical High $288.40 | Professional | 80 · Assistant surgeon | $190.55 | $223.87 | $288.40 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $165.96 Median $199.53 Typical High $251.19 | Professional | AS · PA/NP assist | $165.96 | $199.53 | $251.19 |
CareFirst Setting Professional Modifier None Typical Low $1,258.93 Median $1,380.38 Typical High $1,819.70 | Professional | None | $1,258.93 | $1,380.38 | $1,819.70 |
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 $1,174.90 Median $1,380.38 Typical High $2,137.96 | Professional | None | $1,174.90 | $1,380.38 | $2,137.96 |
Kaiser Permanente Setting Professional Modifier None Typical Low $1,148.15 Median $1,380.38 Typical High $1,698.24 | Professional | None | $1,148.15 | $1,380.38 | $1,698.24 |
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 $1,412.54 Median $1,584.89 Typical High $2,290.87 | Facility | None | $1,412.54 | $1,584.89 | $2,290.87 |
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 $1,023.29 Median $1,862.09 Typical High $5,888.44 | Facility | None | $1,023.29 | $1,862.09 | $5,888.44 |
Sentara Setting Professional Modifier None Typical Low $1,202.26 Median $1,621.81 Typical High $3,019.95 | Professional | None | $1,202.26 | $1,621.81 | $3,019.95 |
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 $1,023.29 Median $1,584.89 Typical High $2,398.83 | Professional | None | $1,023.29 | $1,584.89 | $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 $630.96 Median $707.95 Typical High $707.95 | Professional | 52 · Reduced service | $630.96 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $281.84 Typical High $281.84 | Professional | 53 · Discontinued | $251.19 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $954.99 Median $1,071.52 Typical High $1,071.52 | Professional | 54 · Surgery only | $954.99 | $1,071.52 | $1,071.52 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $190.55 Median $213.80 Typical High $213.80 | Professional | 55 · Aftercare only | $190.55 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $141.25 Typical High $141.25 | Professional | 56 · Pre-op care only | $125.89 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $891.25 Median $1,000.00 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $891.25 | $1,000.00 | $1,000.00 |
Where Virginia 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.