How much rates vary
Facilitymedian $2,239 · 10th to 90th $813 to $3,890Professionalmedian $794 · 10th to 90th $603 to $1,148
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 $645.65 Median $794.33 Typical High $794.33 | Professional | None | $645.65 | $794.33 | $794.33 |
Anthem BCBS Setting Professional Modifier None Typical Low $575.44 Median $758.58 Typical High $1,148.15 | Professional | None | $575.44 | $758.58 | $1,148.15 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $870.96 Median $1,148.15 Typical High $1,698.24 | Professional | 50 · Both sides | $870.96 | $1,148.15 | $1,698.24 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $363.08 Median $478.63 Typical High $707.95 | Professional | 62 · Two surgeons | $363.08 | $478.63 | $707.95 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $93.33 Median $120.23 Typical High $181.97 | Professional | 80 · Assistant surgeon | $93.33 | $120.23 | $181.97 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $81.28 Median $107.15 Typical High $158.49 | Professional | AS · PA/NP assist | $81.28 | $107.15 | $158.49 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $2,238.72 Typical High $2,951.21 | Facility | None | $812.83 | $2,238.72 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $676.08 Median $851.14 Typical High $1,288.25 | Professional | None | $676.08 | $851.14 | $1,288.25 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $616.60 Median $776.25 Typical High $1,096.48 | Professional | None | $616.60 | $776.25 | $1,096.48 |
Martin's Point Setting Professional Modifier None Typical Low $707.95 Median $794.33 Typical High $794.33 | Professional | None | $707.95 | $794.33 | $794.33 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
United Setting Professional Modifier None Typical Low $602.56 Median $812.83 Typical High $1,096.48 | Professional | None | $602.56 | $812.83 | $1,096.48 |
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 $323.59 Median $398.11 Typical High $398.11 | Professional | 52 · Reduced service | $323.59 | $398.11 | $398.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $128.82 Median $158.49 Typical High $158.49 | Professional | 53 · Discontinued | $128.82 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $478.63 Median $588.84 Typical High $588.84 | Professional | 54 · Surgery only | $478.63 | $588.84 | $588.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $117.49 Typical High $117.49 | Professional | 55 · Aftercare only | $95.50 | $117.49 | $117.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $64.57 Median $79.43 Typical High $79.43 | Professional | 56 · Pre-op care only | $64.57 | $79.43 | $79.43 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $446.68 Median $549.54 Typical High $549.54 | Professional | 78 · Unplanned return to OR | $446.68 | $549.54 | $549.54 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $354.81 Median $398.11 Typical High $398.11 | Professional | 52 · Reduced service | $354.81 | $398.11 | $398.11 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $141.25 Median $158.49 Typical High $158.49 | Professional | 53 · Discontinued | $141.25 | $158.49 | $158.49 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $537.03 Median $588.84 Typical High $588.84 | Professional | 54 · Surgery only | $537.03 | $588.84 | $588.84 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $107.15 Median $117.49 Typical High $117.49 | Professional | 55 · Aftercare only | $107.15 | $117.49 | $117.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $70.79 Median $79.43 Typical High $79.43 | Professional | 56 · Pre-op care only | $70.79 | $79.43 | $79.43 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $501.19 Median $549.54 Typical High $549.54 | Professional | 78 · Unplanned return to OR | $501.19 | $549.54 | $549.54 |
Where Maine sits
The same service costs 4.2 times more in Wisconsin 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
WI $7,788MT $1,867
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.