How much rates vary
Facilitymedian $5,888 · 10th to 90th $1,175 to $15,136Professionalmedian $912 · 10th to 90th $617 to $1,288
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 $676.08 Median $5,011.87 Typical High $14,125.38 | Facility | None | $676.08 | $5,011.87 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $616.60 Median $676.08 Typical High $812.83 | Professional | None | $616.60 | $676.08 | $812.83 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,288.25 Median $7,413.10 Typical High $17,378.01 | Facility | None | $1,288.25 | $7,413.10 | $17,378.01 |
Anthem BCBS Setting Professional Modifier None Typical Low $616.60 Median $1,023.29 Typical High $1,288.25 | Professional | None | $616.60 | $1,023.29 | $1,288.25 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $389.05 Median $645.65 Typical High $812.83 | Professional | 62 · Two surgeons | $389.05 | $645.65 | $812.83 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $97.72 Median $165.96 Typical High $223.87 | Professional | 80 · Assistant surgeon | $97.72 | $165.96 | $223.87 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $85.11 Median $144.54 Typical High $181.97 | Professional | AS · PA/NP assist | $85.11 | $144.54 | $181.97 |
CareSource Setting Facility Modifier None Typical Low $741.31 Median $741.31 Typical High $3,235.94 | Facility | None | $741.31 | $741.31 | $3,235.94 |
Cigna Setting Professional Modifier None Typical Low $794.33 Median $1,445.44 Typical High $2,041.74 | Professional | None | $794.33 | $1,445.44 | $2,041.74 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $912.01 Median $2,454.71 Typical High $4,677.35 | Facility | None | $912.01 | $2,454.71 | $4,677.35 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $741.31 Median $1,000.00 Typical High $1,479.11 | Professional | None | $741.31 | $1,000.00 | $1,479.11 |
United Setting Facility Modifier None Typical Low $1,202.26 Median $4,570.88 Typical High $12,022.64 | Facility | None | $1,202.26 | $4,570.88 | $12,022.64 |
United Setting Professional Modifier None Typical Low $575.44 Median $794.33 Typical High $1,380.38 | Professional | None | $575.44 | $794.33 | $1,380.38 |
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 $309.03 Median $338.84 Typical High $371.54 | Professional | 52 · Reduced service | $309.03 | $338.84 | $371.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $123.03 Median $134.90 Typical High $147.91 | Professional | 53 · Discontinued | $123.03 | $134.90 | $147.91 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $457.09 Median $501.19 Typical High $549.54 | Professional | 54 · Surgery only | $457.09 | $501.19 | $549.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $91.20 Median $100.00 Typical High $109.65 | Professional | 55 · Aftercare only | $91.20 | $100.00 | $109.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $61.66 Median $67.61 Typical High $74.13 | Professional | 56 · Pre-op care only | $61.66 | $67.61 | $74.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $426.58 Median $467.74 Typical High $512.86 | Professional | 78 · Unplanned return to OR | $426.58 | $467.74 | $512.86 |
Where Indiana sits
The same service costs 4.4 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 $9,724MT $2,195
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.