How much rates vary
Facilitymedian $6,457 · 10th to 90th $794 to $28,840Professionalmedian $741 · 10th to 90th $537 to $1,096
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 $602.56 Median $758.58 Typical High $11,220.18 | Facility | None | $602.56 | $758.58 | $11,220.18 |
Aetna Setting Professional Modifier None Typical Low $537.03 Median $562.34 Typical High $912.01 | Professional | None | $537.03 | $562.34 | $912.01 |
Ambetter Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $407.38 | Professional | None | $54.95 | $54.95 | $407.38 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,122.02 Median $14,454.40 Typical High $33,884.42 | Facility | None | $1,122.02 | $14,454.40 | $33,884.42 |
Anthem BCBS Setting Professional Modifier None Typical Low $537.03 Median $794.33 Typical High $1,047.13 | Professional | None | $537.03 | $794.33 | $1,047.13 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $812.83 Median $1,202.26 Typical High $1,584.89 | Professional | 50 · Both sides | $812.83 | $1,202.26 | $1,584.89 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $338.84 Median $501.19 Typical High $660.69 | Professional | 62 · Two surgeons | $338.84 | $501.19 | $660.69 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $87.10 Median $128.82 Typical High $173.78 | Professional | 80 · Assistant surgeon | $87.10 | $128.82 | $173.78 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $75.86 Median $112.20 Typical High $147.91 | Professional | AS · PA/NP assist | $75.86 | $112.20 | $147.91 |
CareSource Setting Facility Modifier None Typical Low $616.60 Median $616.60 Typical High $7,244.36 | Facility | None | $616.60 | $616.60 | $7,244.36 |
Cigna Setting Facility Modifier None Typical Low $630.96 Median $4,168.69 Typical High $7,762.47 | Facility | None | $630.96 | $4,168.69 | $7,762.47 |
Cigna Setting Professional Modifier None Typical Low $602.56 Median $741.31 Typical High $3,981.07 | Professional | None | $602.56 | $741.31 | $3,981.07 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $1,258.93 Median $6,606.93 Typical High $10,471.29 | Facility | None | $1,258.93 | $6,606.93 | $10,471.29 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $645.65 Median $891.25 Typical High $1,230.27 | Professional | None | $645.65 | $891.25 | $1,230.27 |
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 $478.63 Median $630.96 Typical High $1,071.52 | Professional | None | $478.63 | $630.96 | $1,071.52 |
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 $257.04 Median $281.84 Typical High $309.03 | Professional | 52 · Reduced service | $257.04 | $281.84 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $102.33 Median $114.82 Typical High $123.03 | Professional | 53 · Discontinued | $102.33 | $114.82 | $123.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $380.19 Median $426.58 Typical High $467.74 | Professional | 54 · Surgery only | $380.19 | $426.58 | $467.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $77.62 Median $85.11 Typical High $93.33 | Professional | 55 · Aftercare only | $77.62 | $85.11 | $93.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $51.29 Median $56.23 Typical High $61.66 | Professional | 56 · Pre-op care only | $51.29 | $56.23 | $61.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $354.81 Median $398.11 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $354.81 | $398.11 | $436.52 |
Where Indiana sits
The same service costs 15.5 times more in Vermont 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
VT $31,031MT $2,001
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.