How much rates vary
Facilitymedian $6,918 · 10th to 90th $813 to $14,125Professionalmedian $1,259 · 10th to 90th $851 to $1,698
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 $870.96 Median $3,467.37 Typical High $5,011.87 | Facility | None | $870.96 | $3,467.37 | $5,011.87 |
Aetna Setting Professional Modifier None Typical Low $870.96 Median $870.96 Typical High $1,096.48 | Professional | None | $870.96 | $870.96 | $1,096.48 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,862.09 Median $9,549.93 Typical High $16,982.44 | Facility | None | $1,862.09 | $9,549.93 | $16,982.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $851.14 Median $1,288.25 Typical High $1,698.24 | Professional | None | $851.14 | $1,288.25 | $1,698.24 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $537.03 Median $812.83 Typical High $1,096.48 | Professional | 62 · Two surgeons | $537.03 | $812.83 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $138.04 Median $208.93 Typical High $295.12 | Professional | 80 · Assistant surgeon | $138.04 | $208.93 | $295.12 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $120.23 Median $181.97 Typical High $245.47 | Professional | AS · PA/NP assist | $120.23 | $181.97 | $245.47 |
CareSource Setting Facility Modifier None Typical Low $1,000.00 Median $1,000.00 Typical High $1,000.00 | Facility | None | $1,000.00 | $1,000.00 | $1,000.00 |
Cigna Setting Facility Modifier None Typical Low $575.44 Median $1,288.25 Typical High $2,691.53 | Facility | None | $575.44 | $1,288.25 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $891.25 Median $1,148.15 Typical High $1,737.80 | Professional | None | $891.25 | $1,148.15 | $1,737.80 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $912.01 Median $2,137.96 Typical High $2,570.40 | Facility | None | $912.01 | $2,137.96 | $2,570.40 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $1,023.29 Median $1,380.38 Typical High $1,862.09 | Professional | None | $1,023.29 | $1,380.38 | $1,862.09 |
United Setting Facility Modifier None Typical Low $302.00 Median $2,290.87 Typical High $10,232.93 | Facility | None | $302.00 | $2,290.87 | $10,232.93 |
United Setting Professional Modifier None Typical Low $891.25 Median $1,174.90 Typical High $1,819.70 | Professional | None | $891.25 | $1,174.90 | $1,819.70 |
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 $426.58 Median $436.52 Typical High $549.54 | Professional | 52 · Reduced service | $426.58 | $436.52 | $549.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $173.78 Median $173.78 Typical High $218.78 | Professional | 53 · Discontinued | $173.78 | $173.78 | $218.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $645.65 Median $645.65 Typical High $812.83 | Professional | 54 · Surgery only | $645.65 | $645.65 | $812.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $128.82 Median $131.83 Typical High $162.18 | Professional | 55 · Aftercare only | $128.82 | $131.83 | $162.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $87.10 Median $87.10 Typical High $109.65 | Professional | 56 · Pre-op care only | $87.10 | $87.10 | $109.65 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $602.56 Median $602.56 Typical High $758.58 | Professional | 78 · Unplanned return to OR | $602.56 | $602.56 | $758.58 |
Where Indiana sits
The same service costs 9.8 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 $16,204MD $1,659
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.