How much rates vary
Facilitymedian $5,012 · 10th to 90th $977 to $14,791Professionalmedian $977 · 10th to 90th $741 to $1,413
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 $812.83 Median $5,011.87 Typical High $11,220.18 | Facility | None | $812.83 | $5,011.87 | $11,220.18 |
Aetna Setting Professional Modifier None Typical Low $724.44 Median $812.83 Typical High $933.25 | Professional | None | $724.44 | $812.83 | $933.25 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,071.52 Median $7,413.10 Typical High $17,378.01 | Facility | None | $1,071.52 | $7,413.10 | $17,378.01 |
Anthem BCBS Setting Professional Modifier None Typical Low $776.25 Median $1,047.13 Typical High $1,380.38 | Professional | None | $776.25 | $1,047.13 | $1,380.38 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $489.78 Median $660.69 Typical High $870.96 | Professional | 62 · Two surgeons | $489.78 | $660.69 | $870.96 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $123.03 Median $169.82 Typical High $234.42 | Professional | 80 · Assistant surgeon | $123.03 | $169.82 | $234.42 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $107.15 Median $147.91 Typical High $194.98 | Professional | AS · PA/NP assist | $107.15 | $147.91 | $194.98 |
CareSource Setting Facility Modifier None Typical Low $870.96 Median $870.96 Typical High $3,235.94 | Facility | None | $870.96 | $870.96 | $3,235.94 |
Cigna Setting Professional Modifier None Typical Low $870.96 Median $1,479.11 Typical High $2,041.74 | Professional | None | $870.96 | $1,479.11 | $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 $776.25 Median $1,230.27 Typical High $1,737.80 | Professional | None | $776.25 | $1,230.27 | $1,737.80 |
United Setting Facility Modifier None Typical Low $870.96 Median $4,168.69 Typical High $9,120.11 | Facility | None | $870.96 | $4,168.69 | $9,120.11 |
United Setting Professional Modifier None Typical Low $676.08 Median $891.25 Typical High $1,548.82 | Professional | None | $676.08 | $891.25 | $1,548.82 |
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 $363.08 Median $407.38 Typical High $436.52 | Professional | 52 · Reduced service | $363.08 | $407.38 | $436.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $144.54 Median $162.18 Typical High $177.83 | Professional | 53 · Discontinued | $144.54 | $162.18 | $177.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $537.03 Median $616.60 Typical High $660.69 | Professional | 54 · Surgery only | $537.03 | $616.60 | $660.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $107.15 Median $123.03 Typical High $131.83 | Professional | 55 · Aftercare only | $107.15 | $123.03 | $131.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $81.28 Typical High $87.10 | Professional | 56 · Pre-op care only | $72.44 | $81.28 | $87.10 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $501.19 Median $575.44 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $501.19 | $575.44 | $616.60 |
Where Indiana sits
The same service costs 3.4 times more in Wisconsin than in Kansas. 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 $8,857KS $2,587
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.