How much rates vary
Facilitymedian $2,692 · 10th to 90th $813 to $7,079Professionalmedian $692 · 10th to 90th $525 to $1,047
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 $537.03 Median $691.83 Typical High $691.83 | Professional | None | $537.03 | $691.83 | $691.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $537.03 Median $707.95 Typical High $1,047.13 | Professional | None | $537.03 | $707.95 | $1,047.13 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $812.83 Median $1,122.02 Typical High $1,584.89 | Professional | 50 · Both sides | $812.83 | $1,122.02 | $1,584.89 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $87.10 Median $104.71 Typical High $169.82 | Professional | 80 · Assistant surgeon | $87.10 | $104.71 | $169.82 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $75.86 Median $97.72 Typical High $147.91 | Professional | AS · PA/NP assist | $75.86 | $97.72 | $147.91 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $4,168.69 Typical High $6,606.93 | Facility | None | $812.83 | $4,168.69 | $6,606.93 |
Cigna Setting Professional Modifier None Typical Low $616.60 Median $758.58 Typical High $1,096.48 | Professional | None | $616.60 | $758.58 | $1,096.48 |
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 $524.81 Median $660.69 Typical High $1,000.00 | Professional | None | $524.81 | $660.69 | $1,000.00 |
Martin's Point Setting Professional Modifier None Typical Low $537.03 Median $691.83 Typical High $691.83 | Professional | None | $537.03 | $691.83 | $691.83 |
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 $512.86 Median $660.69 Typical High $891.25 | Professional | None | $512.86 | $660.69 | $891.25 |
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 $275.42 Median $346.74 Typical High $346.74 | Professional | 52 · Reduced service | $275.42 | $346.74 | $346.74 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $112.20 Median $138.04 Typical High $138.04 | Professional | 53 · Discontinued | $112.20 | $138.04 | $138.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $416.87 Median $512.86 Typical High $512.86 | Professional | 54 · Surgery only | $416.87 | $512.86 | $512.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $83.18 Median $102.33 Typical High $102.33 | Professional | 55 · Aftercare only | $83.18 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $54.95 Median $69.18 Typical High $69.18 | Professional | 56 · Pre-op care only | $54.95 | $69.18 | $69.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $389.05 Median $478.63 Typical High $478.63 | Professional | 78 · Unplanned return to OR | $389.05 | $478.63 | $478.63 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $323.59 Median $346.74 Typical High $346.74 | Professional | 52 · Reduced service | $323.59 | $346.74 | $346.74 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $128.82 Median $138.04 Typical High $138.04 | Professional | 53 · Discontinued | $128.82 | $138.04 | $138.04 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $478.63 Median $512.86 Typical High $512.86 | Professional | 54 · Surgery only | $478.63 | $512.86 | $512.86 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $102.33 Typical High $102.33 | Professional | 55 · Aftercare only | $95.50 | $102.33 | $102.33 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $64.57 Median $69.18 Typical High $69.18 | Professional | 56 · Pre-op care only | $64.57 | $69.18 | $69.18 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $446.68 Median $478.63 Typical High $478.63 | Professional | 78 · Unplanned return to OR | $446.68 | $478.63 | $478.63 |
Where Maine sits
The same service costs 7.9 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 $13,941MT $1,762
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.