How much rates vary
Facilitymedian $2,692 · 10th to 90th $891 to $7,079Professionalmedian $891 · 10th to 90th $708 to $1,349
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 $891.25 Median $891.25 Typical High $891.25 | Facility | None | $891.25 | $891.25 | $891.25 |
Aetna Setting Professional Modifier None Typical Low $741.31 Median $891.25 Typical High $1,288.25 | Professional | None | $741.31 | $891.25 | $1,288.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $707.95 Median $912.01 Typical High $1,380.38 | Professional | None | $707.95 | $912.01 | $1,380.38 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,047.13 Median $1,380.38 Typical High $2,041.74 | Professional | 50 · Both sides | $1,047.13 | $1,380.38 | $2,041.74 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $436.52 Median $575.44 Typical High $870.96 | Professional | 62 · Two surgeons | $436.52 | $575.44 | $870.96 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $112.20 Median $144.54 Typical High $218.78 | Professional | 80 · Assistant surgeon | $112.20 | $144.54 | $218.78 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $97.72 Median $128.82 Typical High $190.55 | Professional | AS · PA/NP assist | $97.72 | $128.82 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $5,495.41 Typical High $8,709.64 | Facility | None | $812.83 | $5,495.41 | $8,709.64 |
Cigna Setting Professional Modifier None Typical Low $812.83 Median $1,000.00 Typical High $1,445.44 | Professional | None | $812.83 | $1,000.00 | $1,445.44 |
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 $691.83 Median $891.25 Typical High $1,288.25 | Professional | None | $691.83 | $891.25 | $1,288.25 |
Martin's Point Setting Professional Modifier None Typical Low $758.58 Median $891.25 Typical High $1,288.25 | Professional | None | $758.58 | $891.25 | $1,288.25 |
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 $676.08 Median $891.25 Typical High $1,202.26 | Professional | None | $676.08 | $891.25 | $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 $363.08 Median $446.68 Typical High $446.68 | Professional | 52 · Reduced service | $363.08 | $446.68 | $446.68 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $177.83 Typical High $177.83 | Professional | 53 · Discontinued | $147.91 | $177.83 | $177.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $549.54 Median $676.08 Typical High $676.08 | Professional | 54 · Surgery only | $549.54 | $676.08 | $676.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $109.65 Median $134.90 Typical High $134.90 | Professional | 55 · Aftercare only | $109.65 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $89.13 Typical High $89.13 | Professional | 56 · Pre-op care only | $72.44 | $89.13 | $89.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $512.86 Median $630.96 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $512.86 | $630.96 | $630.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $416.87 Median $446.68 Typical High $446.68 | Professional | 52 · Reduced service | $416.87 | $446.68 | $446.68 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $169.82 Median $177.83 Typical High $177.83 | Professional | 53 · Discontinued | $169.82 | $177.83 | $177.83 |
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 $89.13 Typical High $89.13 | Professional | 56 · Pre-op care only | $85.11 | $89.13 | $89.13 |
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 6.1 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 $13,882MT $2,270
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.