How much rates vary
Facilitymedian $2,512 · 10th to 90th $1,698 to $5,754Professionalmedian $912 · 10th to 90th $708 to $1,380
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 Facility Modifier None Typical Low $912.01 Median $912.01 Typical High $912.01 | Facility | None | $912.01 | $912.01 | $912.01 |
Aetna Setting Professional Modifier None Typical Low $758.58 Median $912.01 Typical High $1,288.25 | Professional | None | $758.58 | $912.01 | $1,288.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $707.95 Median $933.25 Typical High $1,380.38 | Professional | None | $707.95 | $933.25 | $1,380.38 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $446.68 Median $588.84 Typical High $870.96 | Professional | 62 · Two surgeons | $446.68 | $588.84 | $870.96 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $114.82 Median $147.91 Typical High $223.87 | Professional | 80 · Assistant surgeon | $114.82 | $147.91 | $223.87 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $100.00 Median $128.82 Typical High $194.98 | Professional | AS · PA/NP assist | $100.00 | $128.82 | $194.98 |
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 $707.95 Median $891.25 Typical High $1,288.25 | Professional | None | $707.95 | $891.25 | $1,288.25 |
Martin's Point Setting Professional Modifier None Typical Low $758.58 Median $912.01 Typical High $1,288.25 | Professional | None | $758.58 | $912.01 | $1,288.25 |
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 $691.83 Median $933.25 Typical High $1,202.26 | Professional | None | $691.83 | $933.25 | $1,202.26 |
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 $371.54 Median $457.09 Typical High $457.09 | Professional | 52 · Reduced service | $371.54 | $457.09 | $457.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $181.97 Typical High $181.97 | Professional | 53 · Discontinued | $147.91 | $181.97 | $181.97 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $562.34 Median $676.08 Typical High $676.08 | Professional | 54 · Surgery only | $562.34 | $676.08 | $676.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $112.20 Median $134.90 Typical High $134.90 | Professional | 55 · Aftercare only | $112.20 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $74.13 Median $91.20 Typical High $91.20 | Professional | 56 · Pre-op care only | $74.13 | $91.20 | $91.20 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $524.81 Median $630.96 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $524.81 | $630.96 | $630.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $426.58 Median $457.09 Typical High $457.09 | Professional | 52 · Reduced service | $426.58 | $457.09 | $457.09 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $181.97 Typical High $181.97 | Professional | 53 · Discontinued | $169.82 | $181.97 | $181.97 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $630.96 Median $676.08 Typical High $676.08 | Professional | 54 · Surgery only | $630.96 | $676.08 | $676.08 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $125.89 Median $134.90 Typical High $134.90 | Professional | 55 · Aftercare only | $125.89 | $134.90 | $134.90 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $85.11 Median $91.20 Typical High $91.20 | Professional | 56 · Pre-op care only | $85.11 | $91.20 | $91.20 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $588.84 Median $630.96 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $588.84 | $630.96 | $630.96 |
Where Maine 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.