How much rates vary
Facilitymedian $1,995 · 10th to 90th $457 to $13,490Professionalmedian $1,514 · 10th to 90th $1,230 to $2,455
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 $1,288.25 Median $1,513.56 Typical High $1,548.82 | Facility | None | $1,288.25 | $1,513.56 | $1,548.82 |
Aetna Setting Professional Modifier None Typical Low $1,288.25 Median $1,412.54 Typical High $1,548.82 | Professional | None | $1,288.25 | $1,412.54 | $1,548.82 |
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 $1,230.27 Median $1,479.11 Typical High $2,089.30 | Professional | None | $1,230.27 | $1,479.11 | $2,089.30 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $758.58 Median $933.25 Typical High $1,318.26 | Professional | 62 · Two surgeons | $758.58 | $933.25 | $1,318.26 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $194.98 Median $234.42 Typical High $338.84 | Professional | 80 · Assistant surgeon | $194.98 | $234.42 | $338.84 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $169.82 Median $208.93 Typical High $295.12 | Professional | AS · PA/NP assist | $169.82 | $208.93 | $295.12 |
CareSource Setting Facility Modifier None Typical Low $1,230.27 Median $1,479.11 Typical High $2,290.87 | Facility | None | $1,230.27 | $1,479.11 | $2,290.87 |
CareSource Setting Professional Modifier None Typical Low $1,318.26 Median $1,995.26 Typical High $2,344.23 | Professional | None | $1,318.26 | $1,995.26 | $2,344.23 |
Cigna Setting Facility Modifier None Typical Low $34.67 Median $691.83 Typical High $2,630.27 | Facility | None | $34.67 | $691.83 | $2,630.27 |
Cigna Setting Professional Modifier None Typical Low $1,479.11 Median $2,137.96 Typical High $12,022.64 | Professional | None | $1,479.11 | $2,137.96 | $12,022.64 |
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 $1,479.11 Median $1,905.46 Typical High $2,754.23 | Professional | None | $1,479.11 | $1,905.46 | $2,754.23 |
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 $645.65 Median $707.95 Typical High $776.25 | Professional | 52 · Reduced service | $645.65 | $707.95 | $776.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $257.04 Median $281.84 Typical High $309.03 | Professional | 53 · Discontinued | $257.04 | $281.84 | $309.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $977.24 Median $1,047.13 Typical High $1,174.90 | Professional | 54 · Surgery only | $977.24 | $1,047.13 | $1,174.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $194.98 Median $208.93 Typical High $234.42 | Professional | 55 · Aftercare only | $194.98 | $208.93 | $234.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $128.82 Median $141.25 Typical High $154.88 | Professional | 56 · Pre-op care only | $128.82 | $141.25 | $154.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $912.01 Median $977.24 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $912.01 | $977.24 | $1,096.48 |
Where Kentucky sits
The same service costs 15.0 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 $34,449MD $2,300
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.