How much rates vary
Facilitymedian $4,169 · 10th to 90th $912 to $14,454Professionalmedian $676 · 10th to 90th $490 to $1,000
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 $630.96 Median $724.44 Typical High $16,595.87 | Facility | None | $630.96 | $724.44 | $16,595.87 |
Aetna Setting Professional Modifier None Typical Low $467.74 Median $549.54 Typical High $741.31 | Professional | None | $467.74 | $549.54 | $741.31 |
Ambetter Setting Professional Modifier None Typical Low $776.25 Median $776.25 Typical High $776.25 | Professional | None | $776.25 | $776.25 | $776.25 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,445.44 Median $7,413.10 Typical High $17,378.01 | Facility | None | $1,445.44 | $7,413.10 | $17,378.01 |
Anthem BCBS Setting Professional Modifier None Typical Low $524.81 Median $691.83 Typical High $912.01 | Professional | None | $524.81 | $691.83 | $912.01 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $776.25 Median $1,023.29 Typical High $1,380.38 | Professional | 50 · Both sides | $776.25 | $1,023.29 | $1,380.38 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $323.59 Median $436.52 Typical High $588.84 | Professional | 62 · Two surgeons | $323.59 | $436.52 | $588.84 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $83.18 Median $109.65 Typical High $154.88 | Professional | 80 · Assistant surgeon | $83.18 | $109.65 | $154.88 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $72.44 Median $95.50 Typical High $128.82 | Professional | AS · PA/NP assist | $72.44 | $95.50 | $128.82 |
CareSource Setting Facility Modifier None Typical Low $602.56 Median $602.56 Typical High $3,235.94 | Facility | None | $602.56 | $602.56 | $3,235.94 |
Cigna Setting Facility Modifier None Typical Low $891.25 Median $2,454.71 Typical High $3,801.89 | Facility | None | $891.25 | $2,454.71 | $3,801.89 |
Cigna Setting Professional Modifier None Typical Low $588.84 Median $741.31 Typical High $3,981.07 | Professional | None | $588.84 | $741.31 | $3,981.07 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $1,584.89 Median $3,388.44 Typical High $5,248.07 | Facility | None | $1,584.89 | $3,388.44 | $5,248.07 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $616.60 Median $851.14 Typical High $1,174.90 | Professional | None | $616.60 | $851.14 | $1,174.90 |
United Setting Facility Modifier None Typical Low $870.96 Median $4,168.69 Typical High $9,120.11 | Facility | None | $870.96 | $4,168.69 | $9,120.11 |
United Setting Professional Modifier None Typical Low $467.74 Median $616.60 Typical High $1,023.29 | Professional | None | $467.74 | $616.60 | $1,023.29 |
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 $251.19 Median $275.42 Typical High $302.00 | Professional | 52 · Reduced service | $251.19 | $275.42 | $302.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $100.00 Median $109.65 Typical High $120.23 | Professional | 53 · Discontinued | $100.00 | $109.65 | $120.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $380.19 Median $407.38 Typical High $457.09 | Professional | 54 · Surgery only | $380.19 | $407.38 | $457.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $75.86 Median $83.18 Typical High $91.20 | Professional | 55 · Aftercare only | $75.86 | $83.18 | $91.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $50.12 Median $54.95 Typical High $60.26 | Professional | 56 · Pre-op care only | $50.12 | $54.95 | $60.26 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $354.81 Median $380.19 Typical High $426.58 | Professional | 78 · Unplanned return to OR | $354.81 | $380.19 | $426.58 |
Where Indiana sits
The same service costs 3.9 times more in Wisconsin than in Montana. 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
WI $7,471MT $1,932
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.