How much rates vary
Facilitymedian $1,995 · 10th to 90th $457 to $13,490Professionalmedian $1,549 · 10th to 90th $1,230 to $2,630
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 $1,479.11 Typical High $1,479.11 | Facility | None | $1,288.25 | $1,479.11 | $1,479.11 |
Aetna Setting Professional Modifier None Typical Low $1,288.25 Median $1,380.38 Typical High $1,698.24 | Professional | None | $1,288.25 | $1,380.38 | $1,698.24 |
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 $2,630.27 | Professional | None | $1,230.27 | $1,479.11 | $2,630.27 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $776.25 Median $933.25 Typical High $1,659.59 | Professional | 62 · Two surgeons | $776.25 | $933.25 | $1,659.59 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $194.98 Median $239.88 Typical High $416.87 | Professional | 80 · Assistant surgeon | $194.98 | $239.88 | $416.87 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $169.82 Median $208.93 Typical High $371.54 | Professional | AS · PA/NP assist | $169.82 | $208.93 | $371.54 |
CareSource Setting Facility Modifier None Typical Low $1,202.26 Median $1,445.44 Typical High $2,290.87 | Facility | None | $1,202.26 | $1,445.44 | $2,290.87 |
CareSource Setting Professional Modifier None Typical Low $1,412.54 Median $1,995.26 Typical High $2,344.23 | Professional | None | $1,412.54 | $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 $1,445.44 Median $2,137.96 Typical High $7,762.47 | Professional | None | $1,445.44 | $2,137.96 | $7,762.47 |
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 $2,691.53 | Professional | None | $1,479.11 | $1,905.46 | $2,691.53 |
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 $691.83 Typical High $741.31 | Professional | 52 · Reduced service | $645.65 | $691.83 | $741.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $257.04 Median $275.42 Typical High $295.12 | Professional | 53 · Discontinued | $257.04 | $275.42 | $295.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $954.99 Median $1,047.13 Typical High $1,122.02 | Professional | 54 · Surgery only | $954.99 | $1,047.13 | $1,122.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $190.55 Median $208.93 Typical High $223.87 | Professional | 55 · Aftercare only | $190.55 | $208.93 | $223.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $128.82 Median $138.04 Typical High $147.91 | Professional | 56 · Pre-op care only | $128.82 | $138.04 | $147.91 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $891.25 Median $977.24 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $891.25 | $977.24 | $1,047.13 |
Where Kentucky sits
The same service costs 15.5 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 $2,222
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.