How much rates vary
Facilitymedian $2,512 · 10th to 90th $1,585 to $6,026Professionalmedian $1,349 · 10th to 90th $1,047 to $2,042
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 $1,071.52 Median $1,348.96 Typical High $1,905.46 | Professional | None | $1,071.52 | $1,348.96 | $1,905.46 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,047.13 Median $1,380.38 Typical High $2,041.74 | Professional | None | $1,047.13 | $1,380.38 | $2,041.74 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,584.89 Median $2,041.74 Typical High $3,090.30 | Professional | 50 · Both sides | $1,584.89 | $2,041.74 | $3,090.30 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $660.69 Median $851.14 Typical High $1,288.25 | Professional | 62 · Two surgeons | $660.69 | $851.14 | $1,288.25 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $165.96 Median $218.78 Typical High $331.13 | Professional | 80 · Assistant surgeon | $165.96 | $218.78 | $331.13 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $147.91 Median $190.55 Typical High $288.40 | Professional | AS · PA/NP assist | $147.91 | $190.55 | $288.40 |
Cigna Setting Facility Modifier None Typical Low $1,584.89 Median $4,466.84 Typical High $6,606.93 | Facility | None | $1,584.89 | $4,466.84 | $6,606.93 |
Cigna Setting Professional Modifier None Typical Low $1,202.26 Median $1,479.11 Typical High $2,137.96 | Professional | None | $1,202.26 | $1,479.11 | $2,137.96 |
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 $1,047.13 Median $1,318.26 Typical High $1,905.46 | Professional | None | $1,047.13 | $1,318.26 | $1,905.46 |
Martin's Point Setting Professional Modifier None Typical Low $1,071.52 Median $1,348.96 Typical High $1,905.46 | Professional | None | $1,071.52 | $1,348.96 | $1,905.46 |
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 $1,023.29 Median $1,318.26 Typical High $1,778.28 | Professional | None | $1,023.29 | $1,318.26 | $1,778.28 |
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 $549.54 Median $676.08 Typical High $676.08 | Professional | 52 · Reduced service | $549.54 | $676.08 | $676.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $218.78 Median $269.15 Typical High $269.15 | Professional | 53 · Discontinued | $218.78 | $269.15 | $269.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $812.83 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $162.18 Median $204.17 Typical High $204.17 | Professional | 55 · Aftercare only | $162.18 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $134.90 Typical High $134.90 | Professional | 56 · Pre-op care only | $109.65 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $758.58 | $933.25 | $933.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $630.96 Median $676.08 Typical High $676.08 | Professional | 52 · Reduced service | $630.96 | $676.08 | $676.08 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $269.15 Typical High $269.15 | Professional | 53 · Discontinued | $251.19 | $269.15 | $269.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $954.99 Median $1,000.00 Typical High $1,000.00 | Professional | 54 · Surgery only | $954.99 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $190.55 Median $204.17 Typical High $204.17 | Professional | 55 · Aftercare only | $190.55 | $204.17 | $204.17 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $134.90 Typical High $134.90 | Professional | 56 · Pre-op care only | $125.89 | $134.90 | $134.90 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $891.25 Median $933.25 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $891.25 | $933.25 | $933.25 |
Where Maine sits
The same service costs 4.2 times more in Colorado 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
CO $14,362MT $3,396
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.