How much rates vary
Facilitymedian $2,455 · 10th to 90th $933 to $5,754Professionalmedian $933 · 10th to 90th $741 to $1,445
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 $933.25 Median $933.25 Typical High $933.25 | Facility | None | $933.25 | $933.25 | $933.25 |
Aetna Setting Professional Modifier None Typical Low $758.58 Median $933.25 Typical High $1,380.38 | Professional | None | $758.58 | $933.25 | $1,380.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $741.31 Median $954.99 Typical High $1,445.44 | Professional | None | $741.31 | $954.99 | $1,445.44 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,096.48 Median $1,445.44 Typical High $2,137.96 | Professional | 50 · Both sides | $1,096.48 | $1,445.44 | $2,137.96 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $457.09 Median $602.56 Typical High $912.01 | Professional | 62 · Two surgeons | $457.09 | $602.56 | $912.01 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $117.49 Median $151.36 Typical High $229.09 | Professional | 80 · Assistant surgeon | $117.49 | $151.36 | $229.09 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $102.33 Median $134.90 Typical High $199.53 | Professional | AS · PA/NP assist | $102.33 | $134.90 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $4,168.69 Typical High $6,606.93 | Facility | None | $1,000.00 | $4,168.69 | $6,606.93 |
Cigna Setting Professional Modifier None Typical Low $851.14 Median $1,047.13 Typical High $1,513.56 | Professional | None | $851.14 | $1,047.13 | $1,513.56 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $724.44 Median $933.25 Typical High $1,348.96 | Professional | None | $724.44 | $933.25 | $1,348.96 |
Martin's Point Setting Professional Modifier None Typical Low $758.58 Median $933.25 Typical High $1,380.38 | Professional | None | $758.58 | $933.25 | $1,380.38 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
United Setting Professional Modifier None Typical Low $707.95 Median $933.25 Typical High $1,258.93 | Professional | None | $707.95 | $933.25 | $1,258.93 |
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 $380.19 Median $467.74 Typical High $467.74 | Professional | 52 · Reduced service | $380.19 | $467.74 | $467.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $190.55 Typical High $190.55 | Professional | 53 · Discontinued | $154.88 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $575.44 Median $707.95 Typical High $707.95 | Professional | 54 · Surgery only | $575.44 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $141.25 Typical High $141.25 | Professional | 55 · Aftercare only | $114.82 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $93.33 Typical High $93.33 | Professional | 56 · Pre-op care only | $75.86 | $93.33 | $93.33 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $660.69 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $537.03 | $660.69 | $660.69 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $436.52 Median $467.74 Typical High $467.74 | Professional | 52 · Reduced service | $436.52 | $467.74 | $467.74 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $177.83 Median $190.55 Typical High $190.55 | Professional | 53 · Discontinued | $177.83 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $660.69 Median $707.95 Typical High $707.95 | Professional | 54 · Surgery only | $660.69 | $707.95 | $707.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $131.83 Median $141.25 Typical High $141.25 | Professional | 55 · Aftercare only | $131.83 | $141.25 | $141.25 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $87.10 Median $93.33 Typical High $93.33 | Professional | 56 · Pre-op care only | $87.10 | $93.33 | $93.33 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $616.60 Median $660.69 Typical High $660.69 | Professional | 78 · Unplanned return to OR | $616.60 | $660.69 | $660.69 |
Where Maine sits
The same service costs 5.7 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 $13,613MT $2,377
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.