How much rates vary
Facilitymedian $4,786 · 10th to 90th $676 to $25,704Professionalmedian $2,951 · 10th to 90th $1,622 to $4,467
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 $4,365.16 Median $5,754.40 Typical High $8,511.38 | Facility | None | $4,365.16 | $5,754.40 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $1,862.09 Median $3,090.30 Typical High $3,090.30 | Professional | None | $1,862.09 | $3,090.30 | $3,090.30 |
Anthem BCBS Setting Facility Modifier None Typical Low $7,585.78 Median $23,442.29 Typical High $28,183.83 | Facility | None | $7,585.78 | $23,442.29 | $28,183.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,659.59 Median $3,019.95 Typical High $3,981.07 | Professional | None | $1,659.59 | $3,019.95 | $3,981.07 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,122.02 Median $1,905.46 Typical High $2,570.40 | Professional | 62 · Two surgeons | $1,122.02 | $1,905.46 | $2,570.40 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $269.15 Median $467.74 Typical High $630.96 | Professional | 80 · Assistant surgeon | $269.15 | $467.74 | $630.96 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $234.42 Median $407.38 Typical High $549.54 | Professional | AS · PA/NP assist | $234.42 | $407.38 | $549.54 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $1,000.00 Typical High $27,542.29 | Facility | None | $501.19 | $1,000.00 | $27,542.29 |
Cigna Setting Professional Modifier None Typical Low $2,630.27 Median $2,818.38 Typical High $5,128.61 | Professional | None | $2,630.27 | $2,818.38 | $5,128.61 |
ConnectiCare Setting Professional Modifier None Typical Low $2,089.30 Median $2,630.27 Typical High $3,162.28 | Professional | None | $2,089.30 | $2,630.27 | $3,162.28 |
United Setting Facility Modifier None Typical Low $537.03 Median $1,258.93 Typical High $7,413.10 | Facility | None | $537.03 | $1,258.93 | $7,413.10 |
United Setting Professional Modifier None Typical Low $1,445.44 Median $2,570.40 Typical High $5,623.41 | Professional | None | $1,445.44 | $2,570.40 | $5,623.41 |
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 $1,047.13 Median $1,548.82 Typical High $1,548.82 | Professional | 52 · Reduced service | $1,047.13 | $1,548.82 | $1,548.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $416.87 Median $616.60 Typical High $616.60 | Professional | 53 · Discontinued | $416.87 | $616.60 | $616.60 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,548.82 Median $2,344.23 Typical High $2,344.23 | Professional | 54 · Surgery only | $1,548.82 | $2,344.23 | $2,344.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $309.03 Median $467.74 Typical High $467.74 | Professional | 55 · Aftercare only | $309.03 | $467.74 | $467.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $208.93 Median $309.03 Typical High $309.03 | Professional | 56 · Pre-op care only | $208.93 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $2,187.76 Typical High $2,187.76 | Professional | 78 · Unplanned return to OR | $1,445.44 | $2,187.76 | $2,187.76 |
Where Connecticut sits
The same service costs 14.4 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 $34,547MD $2,395
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.