How much rates vary
Facilitymedian $1,738 · 10th to 90th $550 to $8,318Professionalmedian $3,631 · 10th to 90th $2,344 to $5,129
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 $4,466.84 Median $4,466.84 Typical High $5,495.41 | Facility | None | $4,466.84 | $4,466.84 | $5,495.41 |
Aetna Setting Professional Modifier None Typical Low $2,570.40 Median $5,128.61 Typical High $5,128.61 | Professional | None | $2,570.40 | $5,128.61 | $5,128.61 |
BCBS Setting Facility Modifier None Typical Low $7,762.47 Median $8,128.31 Typical High $10,000.00 | Facility | None | $7,762.47 | $8,128.31 | $10,000.00 |
BCBS Setting Professional Modifier None Typical Low $3,388.44 Median $3,981.07 Typical High $4,265.80 | Professional | None | $3,388.44 | $3,981.07 | $4,265.80 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $1,380.38 Typical High $12,589.25 | Facility | None | $151.36 | $1,380.38 | $12,589.25 |
Cigna Setting Professional Modifier None Typical Low $2,570.40 Median $3,019.95 Typical High $3,630.78 | Professional | None | $2,570.40 | $3,019.95 | $3,630.78 |
Moda Health Setting Facility Modifier None Typical Low $1,737.80 Median $5,128.61 Typical High $7,413.10 | Facility | None | $1,737.80 | $5,128.61 | $7,413.10 |
Moda Health Setting Professional Modifier None Typical Low $2,691.53 Median $3,801.89 Typical High $5,128.61 | Professional | None | $2,691.53 | $3,801.89 | $5,128.61 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $2,951.21 Median $3,630.78 Typical High $3,630.78 | Facility | None | $2,951.21 | $3,630.78 | $3,630.78 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $3,630.78 Median $3,630.78 Typical High $4,570.88 | Professional | None | $3,630.78 | $3,630.78 | $4,570.88 |
Regence BlueShield Setting Professional Modifier None Typical Low $3,630.78 Median $4,265.80 Typical High $5,128.61 | Professional | None | $3,630.78 | $4,265.80 | $5,128.61 |
Select Health Setting Facility Modifier None Typical Low $1,737.80 Median $1,737.80 Typical High $1,862.09 | Facility | None | $1,737.80 | $1,737.80 | $1,862.09 |
Select Health Setting Professional Modifier None Typical Low $1,737.80 Median $1,737.80 Typical High $2,630.27 | Professional | None | $1,737.80 | $1,737.80 | $2,630.27 |
United Setting Facility Modifier None Typical Low $436.52 Median $676.08 Typical High $870.96 | Facility | None | $436.52 | $676.08 | $870.96 |
United Setting Professional Modifier None Typical Low $2,089.30 Median $3,090.30 Typical High $4,570.88 | Professional | None | $2,089.30 | $3,090.30 | $4,570.88 |
21 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 $1,288.25 Median $2,570.40 Typical High $2,570.40 | Professional | 52 · Reduced service | $1,288.25 | $2,570.40 | $2,570.40 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $512.86 Median $1,023.29 Typical High $1,023.29 | Professional | 53 · Discontinued | $512.86 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,905.46 Median $3,890.45 Typical High $3,890.45 | Professional | 54 · Surgery only | $1,905.46 | $3,890.45 | $3,890.45 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $389.05 Median $776.25 Typical High $776.25 | Professional | 55 · Aftercare only | $389.05 | $776.25 | $776.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $257.04 Median $512.86 Typical High $512.86 | Professional | 56 · Pre-op care only | $257.04 | $512.86 | $512.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,778.28 Median $3,630.78 Typical High $3,630.78 | Professional | 78 · Unplanned return to OR | $1,778.28 | $3,630.78 | $3,630.78 |
BCBS Setting Professional Modifier 54 · Surgery only Typical Low $2,951.21 Median $3,467.37 Typical High $3,715.35 | Professional | 54 · Surgery only | $2,951.21 | $3,467.37 | $3,715.35 |
BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $331.13 Median $389.05 Typical High $407.38 | Professional | 55 · Aftercare only | $331.13 | $389.05 | $407.38 |
BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,041.74 Median $2,454.71 Typical High $2,570.40 | Professional | 62 · Two surgeons | $2,041.74 | $2,454.71 | $2,570.40 |
BCBS Setting Professional Modifier 63 · Small infant Typical Low $3,981.07 Median $4,677.35 Typical High $4,897.79 | Professional | 63 · Small infant | $3,981.07 | $4,677.35 | $4,897.79 |
BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,290.87 Median $2,754.23 Typical High $2,884.03 | Professional | 78 · Unplanned return to OR | $2,290.87 | $2,754.23 | $2,884.03 |
BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $524.81 Median $616.60 Typical High $660.69 | Professional | 80 · Assistant surgeon | $524.81 | $616.60 | $660.69 |
BCBS Setting Professional Modifier 81 · Minimal assistant surgeon Typical Low $524.81 Median $616.60 Typical High $660.69 | Professional | 81 · Minimal assistant surgeon | $524.81 | $616.60 | $660.69 |
BCBS Setting Professional Modifier 82 · Assistant surgeon, no resident Typical Low $524.81 Median $616.60 Typical High $660.69 | Professional | 82 · Assistant surgeon, no resident | $524.81 | $616.60 | $660.69 |
BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $446.68 Median $524.81 Typical High $562.34 | Professional | AS · PA/NP assist | $446.68 | $524.81 | $562.34 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $1,348.96 Median $2,570.40 Typical High $2,570.40 | Professional | 52 · Reduced service | $1,348.96 | $2,570.40 | $2,570.40 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $549.54 Median $1,023.29 Typical High $1,023.29 | Professional | 53 · Discontinued | $549.54 | $1,023.29 | $1,023.29 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $2,041.74 Median $3,890.45 Typical High $3,890.45 | Professional | 54 · Surgery only | $2,041.74 | $3,890.45 | $3,890.45 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $407.38 Median $776.25 Typical High $776.25 | Professional | 55 · Aftercare only | $407.38 | $776.25 | $776.25 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $269.15 Median $512.86 Typical High $512.86 | Professional | 56 · Pre-op care only | $269.15 | $512.86 | $512.86 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,905.46 Median $3,630.78 Typical High $3,630.78 | Professional | 78 · Unplanned return to OR | $1,905.46 | $3,630.78 | $3,630.78 |
Where Idaho 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 $35,311WA $2,561
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.