How much rates vary
Facilitymedian $5,012 · 10th to 90th $501 to $23,442Professionalmedian $1,862 · 10th to 90th $275 to $2,951
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 $1,698.24 Median $1,698.24 Typical High $9,120.11 | Professional | None | $1,698.24 | $1,698.24 | $9,120.11 |
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 $1,412.54 Median $1,862.09 Typical High $3,019.95 | Professional | None | $1,412.54 | $1,862.09 | $3,019.95 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $891.25 Median $1,174.90 Typical High $1,905.46 | Professional | 62 · Two surgeons | $891.25 | $1,174.90 | $1,905.46 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $229.09 Median $295.12 Typical High $489.78 | Professional | 80 · Assistant surgeon | $229.09 | $295.12 | $489.78 |
CareSource Setting Facility Modifier None Typical Low $2,344.23 Median $2,344.23 Typical High $2,344.23 | Facility | None | $2,344.23 | $2,344.23 | $2,344.23 |
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 $1,778.28 Median $2,454.71 Typical High $3,981.07 | Professional | None | $1,778.28 | $2,454.71 | $3,981.07 |
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 $1,778.28 Median $2,454.71 Typical High $3,981.07 | Professional | None | $1,778.28 | $2,454.71 | $3,981.07 |
Molina Setting Professional Modifier None Typical Low $239.88 Median $1,819.70 Typical High $2,630.27 | Professional | None | $239.88 | $1,819.70 | $2,630.27 |
SummaCare Setting Professional Modifier None Typical Low $1,862.09 Median $1,862.09 Typical High $2,818.38 | Professional | None | $1,862.09 | $1,862.09 | $2,818.38 |
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 $1,778.28 Median $2,398.83 Typical High $4,677.35 | Professional | None | $1,778.28 | $2,398.83 | $4,677.35 |
7 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 $851.14 Median $851.14 Typical High $3,801.89 | Professional | 52 · Reduced service | $851.14 | $851.14 | $3,801.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $338.84 Typical High $1,513.56 | Professional | 53 · Discontinued | $338.84 | $338.84 | $1,513.56 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,288.25 Median $1,288.25 Typical High $5,623.41 | Professional | 54 · Surgery only | $1,288.25 | $1,288.25 | $5,623.41 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $257.04 Typical High $1,148.15 | Professional | 55 · Aftercare only | $257.04 | $257.04 | $1,148.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $169.82 Typical High $758.58 | Professional | 56 · Pre-op care only | $169.82 | $169.82 | $758.58 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $1,202.26 Typical High $5,248.07 | Professional | 78 · Unplanned return to OR | $1,202.26 | $1,202.26 | $5,248.07 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $199.53 Median $257.04 Typical High $416.87 | Professional | AS · PA/NP assist | $199.53 | $257.04 | $416.87 |
Where Ohio 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.