How much rates vary
Facilitymedian $8,913 · 10th to 90th $955 to $28,840Professionalmedian $871 · 10th to 90th $589 to $1,349
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 $5,011.87 Typical High $11,220.18 | Facility | None | $630.96 | $5,011.87 | $11,220.18 |
Aetna Setting Professional Modifier None Typical Low $575.44 Median $630.96 Typical High $831.76 | Professional | None | $575.44 | $630.96 | $831.76 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,230.27 Median $14,454.40 Typical High $33,113.11 | Facility | None | $1,230.27 | $14,454.40 | $33,113.11 |
Anthem BCBS Setting Professional Modifier None Typical Low $575.44 Median $977.24 Typical High $1,230.27 | Professional | None | $575.44 | $977.24 | $1,230.27 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $870.96 Median $1,445.44 Typical High $1,819.70 | Professional | 50 · Both sides | $870.96 | $1,445.44 | $1,819.70 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $93.33 Median $154.88 Typical High $208.93 | Professional | 80 · Assistant surgeon | $93.33 | $154.88 | $208.93 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $81.28 Median $134.90 Typical High $169.82 | Professional | AS · PA/NP assist | $81.28 | $134.90 | $169.82 |
CareSource Setting Facility Modifier None Typical Low $691.83 Median $691.83 Typical High $10,000.00 | Facility | None | $691.83 | $691.83 | $10,000.00 |
Cigna Setting Facility Modifier None Typical Low $630.96 Median $6,165.95 Typical High $10,232.93 | Facility | None | $630.96 | $6,165.95 | $10,232.93 |
Cigna Setting Professional Modifier None Typical Low $691.83 Median $1,023.29 Typical High $6,025.60 | Professional | None | $691.83 | $1,023.29 | $6,025.60 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $912.01 Median $7,244.36 Typical High $12,589.25 | Facility | None | $912.01 | $7,244.36 | $12,589.25 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $691.83 Median $954.99 Typical High $1,380.38 | Professional | None | $691.83 | $954.99 | $1,380.38 |
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 $549.54 Median $741.31 Typical High $1,288.25 | Professional | None | $549.54 | $741.31 | $1,288.25 |
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 $288.40 Median $316.23 Typical High $346.74 | Professional | 52 · Reduced service | $288.40 | $316.23 | $346.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $114.82 Median $125.89 Typical High $138.04 | Professional | 53 · Discontinued | $114.82 | $125.89 | $138.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $436.52 Median $478.63 Typical High $512.86 | Professional | 54 · Surgery only | $436.52 | $478.63 | $512.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $87.10 Median $95.50 Typical High $104.71 | Professional | 55 · Aftercare only | $87.10 | $95.50 | $104.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $57.54 Median $63.10 Typical High $69.18 | Professional | 56 · Pre-op care only | $57.54 | $63.10 | $69.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $407.38 Median $446.68 Typical High $478.63 | Professional | 78 · Unplanned return to OR | $407.38 | $446.68 | $478.63 |
Where Indiana sits
The same service costs 6.4 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 $13,837MT $2,168
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.