How much rates vary
Facilitymedian $13,490 · 10th to 90th $891 to $30,903Professionalmedian $2,138 · 10th to 90th $1,549 to $3,090
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 $1,621.81 Median $3,467.37 Typical High $5,011.87 | Facility | None | $1,621.81 | $3,467.37 | $5,011.87 |
Aetna Setting Professional Modifier None Typical Low $1,621.81 Median $1,621.81 Typical High $1,949.84 | Professional | None | $1,621.81 | $1,621.81 | $1,949.84 |
Anthem BCBS Setting Facility Modifier None Typical Low $2,691.53 Median $20,892.96 Typical High $32,359.37 | Facility | None | $2,691.53 | $20,892.96 | $32,359.37 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,548.82 Median $2,137.96 Typical High $2,754.23 | Professional | None | $1,548.82 | $2,137.96 | $2,754.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $977.24 Median $1,348.96 Typical High $1,778.28 | Professional | 62 · Two surgeons | $977.24 | $1,348.96 | $1,778.28 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $245.47 Median $338.84 Typical High $467.74 | Professional | 80 · Assistant surgeon | $245.47 | $338.84 | $467.74 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $213.80 Median $302.00 Typical High $398.11 | Professional | AS · PA/NP assist | $213.80 | $302.00 | $398.11 |
CareSource Setting Facility Modifier None Typical Low $1,862.09 Median $1,862.09 Typical High $1,862.09 | Facility | None | $1,862.09 | $1,862.09 | $1,862.09 |
Cigna Setting Facility Modifier None Typical Low $512.86 Median $933.25 Typical High $2,691.53 | Facility | None | $512.86 | $933.25 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $1,659.59 Median $2,137.96 Typical High $10,000.00 | Professional | None | $1,659.59 | $2,137.96 | $10,000.00 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $912.01 Median $2,344.23 Typical High $4,786.30 | Facility | None | $912.01 | $2,344.23 | $4,786.30 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $1,698.24 Median $2,454.71 Typical High $3,388.44 | Professional | None | $1,698.24 | $2,454.71 | $3,388.44 |
United Setting Facility Modifier None Typical Low $302.00 Median $2,454.71 Typical High $10,715.19 | Facility | None | $302.00 | $2,454.71 | $10,715.19 |
United Setting Professional Modifier None Typical Low $1,445.44 Median $1,949.84 Typical High $3,162.28 | Professional | None | $1,445.44 | $1,949.84 | $3,162.28 |
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 $812.83 Median $812.83 Typical High $977.24 | Professional | 52 · Reduced service | $812.83 | $812.83 | $977.24 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $323.59 Median $323.59 Typical High $389.05 | Professional | 53 · Discontinued | $323.59 | $323.59 | $389.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,230.27 Typical High $1,479.11 | Professional | 54 · Surgery only | $1,202.26 | $1,230.27 | $1,479.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $245.47 Typical High $295.12 | Professional | 55 · Aftercare only | $239.88 | $245.47 | $295.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $162.18 Median $162.18 Typical High $194.98 | Professional | 56 · Pre-op care only | $162.18 | $162.18 | $194.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,148.15 Typical High $1,380.38 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,148.15 | $1,380.38 |
Where Indiana 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.