How much rates vary
Facilitymedian $2,512 · 10th to 90th $1,148 to $6,026Professionalmedian $1,047 · 10th to 90th $813 to $1,585
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 Professional Modifier None Typical Low $831.76 Median $1,047.13 Typical High $1,513.56 | Professional | None | $831.76 | $1,047.13 | $1,513.56 |
Anthem BCBS Setting Professional Modifier None Typical Low $812.83 Median $1,047.13 Typical High $1,584.89 | Professional | None | $812.83 | $1,047.13 | $1,584.89 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,202.26 Median $1,584.89 Typical High $2,344.23 | Professional | 50 · Both sides | $1,202.26 | $1,584.89 | $2,344.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $512.86 Median $660.69 Typical High $1,000.00 | Professional | 62 · Two surgeons | $512.86 | $660.69 | $1,000.00 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $128.82 Median $169.82 Typical High $251.19 | Professional | 80 · Assistant surgeon | $128.82 | $169.82 | $251.19 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $112.20 Median $147.91 Typical High $218.78 | Professional | AS · PA/NP assist | $112.20 | $147.91 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $1,148.15 Median $4,168.69 Typical High $6,606.93 | Facility | None | $1,148.15 | $4,168.69 | $6,606.93 |
Cigna Setting Professional Modifier None Typical Low $933.25 Median $1,148.15 Typical High $1,737.80 | Professional | None | $933.25 | $1,148.15 | $1,737.80 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $794.33 Median $1,023.29 Typical High $1,479.11 | Professional | None | $794.33 | $1,023.29 | $1,479.11 |
Martin's Point Setting Professional Modifier None Typical Low $870.96 Median $1,047.13 Typical High $1,513.56 | Professional | None | $870.96 | $1,047.13 | $1,513.56 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
United Setting Professional Modifier None Typical Low $794.33 Median $1,023.29 Typical High $1,380.38 | Professional | None | $794.33 | $1,023.29 | $1,380.38 |
12 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 $512.86 Typical High $512.86 | Professional | 52 · Reduced service | $426.58 | $512.86 | $512.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $208.93 Typical High $208.93 | Professional | 53 · Discontinued | $169.82 | $208.93 | $208.93 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $776.25 Typical High $776.25 | Professional | 54 · Surgery only | $630.96 | $776.25 | $776.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $154.88 Typical High $154.88 | Professional | 55 · Aftercare only | $125.89 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $104.71 Typical High $104.71 | Professional | 56 · Pre-op care only | $85.11 | $104.71 | $104.71 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $724.44 Typical High $724.44 | Professional | 78 · Unplanned return to OR | $588.84 | $724.44 | $724.44 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $489.78 Median $512.86 Typical High $512.86 | Professional | 52 · Reduced service | $489.78 | $512.86 | $512.86 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $194.98 Median $208.93 Typical High $208.93 | Professional | 53 · Discontinued | $194.98 | $208.93 | $208.93 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $724.44 Median $776.25 Typical High $776.25 | Professional | 54 · Surgery only | $724.44 | $776.25 | $776.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $144.54 Median $154.88 Typical High $154.88 | Professional | 55 · Aftercare only | $144.54 | $154.88 | $154.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $97.72 Median $104.71 Typical High $104.71 | Professional | 56 · Pre-op care only | $97.72 | $104.71 | $104.71 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $676.08 Median $724.44 Typical High $724.44 | Professional | 78 · Unplanned return to OR | $676.08 | $724.44 | $724.44 |
Where Maine sits
The same service costs 5.9 times more in Colorado than in West Virginia. 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
CO $14,031WV $2,390
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.