How much rates vary
Facilitymedian $5,012 · 10th to 90th $501 to $23,442Professionalmedian $1,862 · 10th to 90th $269 to $3,020
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 $2,454.71 Median $9,332.54 Typical High $12,589.25 | Facility | None | $2,454.71 | $9,332.54 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $1,819.70 Median $1,819.70 Typical High $9,332.54 | Professional | None | $1,819.70 | $1,819.70 | $9,332.54 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,479.11 Median $12,022.64 Typical High $28,183.83 | Facility | None | $1,479.11 | $12,022.64 | $28,183.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,513.56 Median $1,862.09 Typical High $3,162.28 | Professional | None | $1,513.56 | $1,862.09 | $3,162.28 |
CareSource Setting Facility Modifier None Typical Low $2,511.89 Median $2,511.89 Typical High $2,511.89 | Facility | None | $2,511.89 | $2,511.89 | $2,511.89 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,691.53 | Facility | None | $426.58 | $588.84 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,905.46 Median $2,570.40 Typical High $4,265.80 | Professional | None | $1,905.46 | $2,570.40 | $4,265.80 |
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 $2,570.40 Typical High $4,265.80 | Professional | None | $1,905.46 | $2,570.40 | $4,265.80 |
Molina Setting Professional Modifier None Typical Low $245.47 Median $1,698.24 Typical High $2,691.53 | Professional | None | $245.47 | $1,698.24 | $2,691.53 |
SummaCare Setting Professional Modifier None Typical Low $1,995.26 Median $1,995.26 Typical High $3,019.95 | Professional | None | $1,995.26 | $1,995.26 | $3,019.95 |
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 $1,905.46 Median $2,511.89 Typical High $4,897.79 | Professional | None | $1,905.46 | $2,511.89 | $4,897.79 |
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 $912.01 Median $912.01 Typical High $4,073.80 | Professional | 52 · Reduced service | $912.01 | $912.01 | $4,073.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $363.08 Median $363.08 Typical High $1,621.81 | Professional | 53 · Discontinued | $363.08 | $363.08 | $1,621.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,348.96 Median $1,348.96 Typical High $6,165.95 | Professional | 54 · Surgery only | $1,348.96 | $1,348.96 | $6,165.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $269.15 Median $269.15 Typical High $1,230.27 | Professional | 55 · Aftercare only | $269.15 | $269.15 | $1,230.27 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $181.97 Median $181.97 Typical High $812.83 | Professional | 56 · Pre-op care only | $181.97 | $181.97 | $812.83 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,258.93 Median $1,258.93 Typical High $5,754.40 | Professional | 78 · Unplanned return to OR | $1,258.93 | $1,258.93 | $5,754.40 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $933.25 Median $1,174.90 Typical High $1,995.26 | Professional | 62 · Two surgeons | $933.25 | $1,174.90 | $1,995.26 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $239.88 Median $295.12 Typical High $512.86 | Professional | 80 · Assistant surgeon | $239.88 | $295.12 | $512.86 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $208.93 Median $257.04 Typical High $436.52 | Professional | AS · PA/NP assist | $208.93 | $257.04 | $436.52 |
Where Ohio sits
The same service costs 13.8 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 $35,114WA $2,549
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.