How much rates vary
Facilitymedian $2,692 · 10th to 90th $525 to $10,000Professionalmedian $1,479 · 10th to 90th $977 to $3,311
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 $1,202.26 Median $4,897.79 Typical High $7,762.47 | Facility | None | $1,202.26 | $4,897.79 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $812.83 Median $977.24 Typical High $1,288.25 | Professional | None | $812.83 | $977.24 | $1,288.25 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,412.54 Median $3,801.89 Typical High $10,000.00 | Facility | None | $1,412.54 | $3,801.89 | $10,000.00 |
Anthem BCBS Setting Professional Modifier None Typical Low $977.24 Median $1,412.54 Typical High $1,949.84 | Professional | None | $977.24 | $1,412.54 | $1,949.84 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $616.60 Median $891.25 Typical High $1,230.27 | Professional | 62 · Two surgeons | $616.60 | $891.25 | $1,230.27 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $151.36 Median $229.09 Typical High $309.03 | Professional | 80 · Assistant surgeon | $151.36 | $229.09 | $309.03 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $134.90 Median $199.53 Typical High $269.15 | Professional | AS · PA/NP assist | $134.90 | $199.53 | $269.15 |
BCBS Kansas City Setting Professional Modifier None Typical Low $977.24 Median $1,071.52 Typical High $1,513.56 | Professional | None | $977.24 | $1,071.52 | $1,513.56 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $691.83 Typical High $2,691.53 | Facility | None | $489.78 | $691.83 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,047.13 Median $1,174.90 Typical High $2,238.72 | Professional | None | $1,047.13 | $1,174.90 | $2,238.72 |
Medica Setting Facility Modifier None Typical Low $54.95 Median $1,230.27 Typical High $10,232.93 | Facility | None | $54.95 | $1,230.27 | $10,232.93 |
Medica Setting Professional Modifier None Typical Low $1,174.90 Median $2,238.72 Typical High $12,302.69 | Professional | None | $1,174.90 | $2,238.72 | $12,302.69 |
United Setting Facility Modifier None Typical Low $467.74 Median $2,290.87 Typical High $10,964.78 | Facility | None | $467.74 | $2,290.87 | $10,964.78 |
United Setting Professional Modifier None Typical Low $1,096.48 Median $1,513.56 Typical High $2,630.27 | Professional | None | $1,096.48 | $1,513.56 | $2,630.27 |
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 $407.38 Median $489.78 Typical High $501.19 | Professional | 52 · Reduced service | $407.38 | $489.78 | $501.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $162.18 Median $194.98 Typical High $199.53 | Professional | 53 · Discontinued | $162.18 | $194.98 | $199.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $616.60 Median $741.31 Typical High $758.58 | Professional | 54 · Surgery only | $616.60 | $741.31 | $758.58 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $123.03 Median $147.91 Typical High $151.36 | Professional | 55 · Aftercare only | $123.03 | $147.91 | $151.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $97.72 Typical High $100.00 | Professional | 56 · Pre-op care only | $81.28 | $97.72 | $100.00 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $575.44 Median $691.83 Typical High $707.95 | Professional | 78 · Unplanned return to OR | $575.44 | $691.83 | $707.95 |
Where Missouri 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.