How much rates vary
Facilitymedian $1,995 · 10th to 90th $457 to $13,490Professionalmedian $1,905 · 10th to 90th $1,514 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 $1,584.89 Median $1,819.70 Typical High $1,949.84 | Facility | None | $1,584.89 | $1,819.70 | $1,949.84 |
Aetna Setting Professional Modifier None Typical Low $1,584.89 Median $1,698.24 Typical High $1,949.84 | Professional | None | $1,584.89 | $1,698.24 | $1,949.84 |
Anthem BCBS Setting Facility Modifier None Typical Low $7,244.36 Median $10,715.19 Typical High $19,498.45 | Facility | None | $7,244.36 | $10,715.19 | $19,498.45 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,513.56 Median $1,819.70 Typical High $2,570.40 | Professional | None | $1,513.56 | $1,819.70 | $2,570.40 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $933.25 Median $1,148.15 Typical High $1,621.81 | Professional | 62 · Two surgeons | $933.25 | $1,148.15 | $1,621.81 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $239.88 Median $288.40 Typical High $407.38 | Professional | 80 · Assistant surgeon | $239.88 | $288.40 | $407.38 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $208.93 Median $251.19 Typical High $363.08 | Professional | AS · PA/NP assist | $208.93 | $251.19 | $363.08 |
CareSource Setting Facility Modifier None Typical Low $1,479.11 Median $1,778.28 Typical High $2,818.38 | Facility | None | $1,479.11 | $1,778.28 | $2,818.38 |
CareSource Setting Professional Modifier None Typical Low $1,584.89 Median $2,454.71 Typical High $2,884.03 | Professional | None | $1,584.89 | $2,454.71 | $2,884.03 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $691.83 Typical High $3,162.28 | Facility | None | $34.67 | $691.83 | $3,162.28 |
Cigna Setting Professional Modifier None Typical Low $1,778.28 Median $2,570.40 Typical High $10,232.93 | Professional | None | $1,778.28 | $2,570.40 | $10,232.93 |
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 $1,819.70 Median $2,290.87 Typical High $3,311.31 | Professional | None | $1,819.70 | $2,290.87 | $3,311.31 |
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 $776.25 Median $851.14 Typical High $977.24 | Professional | 52 · Reduced service | $776.25 | $851.14 | $977.24 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $338.84 Typical High $389.05 | Professional | 53 · Discontinued | $316.23 | $338.84 | $389.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,288.25 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,174.90 | $1,288.25 | $1,445.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $234.42 Median $257.04 Typical High $288.40 | Professional | 55 · Aftercare only | $234.42 | $257.04 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $169.82 Typical High $194.98 | Professional | 56 · Pre-op care only | $158.49 | $169.82 | $194.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,096.48 Median $1,202.26 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,096.48 | $1,202.26 | $1,348.96 |
Where Kentucky sits
The same service costs 13.4 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 $34,930MD $2,604
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.