How much rates vary
Facilitymedian $2,692 · 10th to 90th $813 to $7,586Professionalmedian $851 · 10th to 90th $661 to $1,288
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 $660.69 Median $851.14 Typical High $1,023.29 | Professional | None | $660.69 | $851.14 | $1,023.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $660.69 Median $870.96 Typical High $1,288.25 | Professional | None | $660.69 | $870.96 | $1,288.25 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,000.00 Median $1,318.26 Typical High $1,949.84 | Professional | 50 · Both sides | $1,000.00 | $1,318.26 | $1,949.84 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $416.87 Median $549.54 Typical High $812.83 | Professional | 62 · Two surgeons | $416.87 | $549.54 | $812.83 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $107.15 Median $138.04 Typical High $208.93 | Professional | 80 · Assistant surgeon | $107.15 | $138.04 | $208.93 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $93.33 Median $123.03 Typical High $181.97 | Professional | AS · PA/NP assist | $93.33 | $123.03 | $181.97 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $5,248.07 Typical High $8,317.64 | Facility | None | $812.83 | $5,248.07 | $8,317.64 |
Cigna Setting Professional Modifier None Typical Low $776.25 Median $933.25 Typical High $1,348.96 | Professional | None | $776.25 | $933.25 | $1,348.96 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $645.65 Median $831.76 Typical High $1,230.27 | Professional | None | $645.65 | $831.76 | $1,230.27 |
Martin's Point Setting Professional Modifier None Typical Low $676.08 Median $851.14 Typical High $1,023.29 | Professional | None | $676.08 | $851.14 | $1,023.29 |
United Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
United Setting Professional Modifier None Typical Low $645.65 Median $831.76 Typical High $1,122.02 | Professional | None | $645.65 | $831.76 | $1,122.02 |
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 $346.74 Median $426.58 Typical High $426.58 | Professional | 52 · Reduced service | $346.74 | $426.58 | $426.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $138.04 Median $169.82 Typical High $169.82 | Professional | 53 · Discontinued | $138.04 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $512.86 Median $630.96 Typical High $630.96 | Professional | 54 · Surgery only | $512.86 | $630.96 | $630.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $102.33 Median $125.89 Typical High $125.89 | Professional | 55 · Aftercare only | $102.33 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $69.18 Median $85.11 Typical High $85.11 | Professional | 56 · Pre-op care only | $69.18 | $85.11 | $85.11 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $478.63 Median $588.84 Typical High $588.84 | Professional | 78 · Unplanned return to OR | $478.63 | $588.84 | $588.84 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $398.11 Median $426.58 Typical High $426.58 | Professional | 52 · Reduced service | $398.11 | $426.58 | $426.58 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $158.49 Median $169.82 Typical High $169.82 | Professional | 53 · Discontinued | $158.49 | $169.82 | $169.82 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $630.96 Typical High $630.96 | Professional | 54 · Surgery only | $588.84 | $630.96 | $630.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $125.89 Typical High $125.89 | Professional | 55 · Aftercare only | $120.23 | $125.89 | $125.89 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $79.43 Median $85.11 Typical High $85.11 | Professional | 56 · Pre-op care only | $79.43 | $85.11 | $85.11 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $588.84 Typical High $588.84 | Professional | 78 · Unplanned return to OR | $549.54 | $588.84 | $588.84 |
Where Maine 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 $13,816MT $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.