How much rates vary
Facilitymedian $10,965 · 10th to 90th $813 to $58,884Professionalmedian $4,266 · 10th to 90th $3,548 to $7,079
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 $2,344.23 Median $4,570.88 Typical High $5,011.87 | Facility | None | $2,344.23 | $4,570.88 | $5,011.87 |
Aetna Setting Professional Modifier None Typical Low $4,570.88 Median $4,570.88 Typical High $5,754.40 | Professional | None | $4,570.88 | $4,570.88 | $5,754.40 |
Anthem BCBS Setting Facility Modifier None Typical Low $2,511.89 Median $38,018.94 Typical High $77,624.71 | Facility | None | $2,511.89 | $38,018.94 | $77,624.71 |
Anthem BCBS Setting Professional Modifier None Typical Low $3,467.37 Median $4,265.80 Typical High $5,888.44 | Professional | None | $3,467.37 | $4,265.80 | $5,888.44 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $2,187.76 Median $2,691.53 Typical High $3,890.45 | Professional | 62 · Two surgeons | $2,187.76 | $2,691.53 | $3,890.45 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $549.54 Median $691.83 Typical High $1,071.52 | Professional | 80 · Assistant surgeon | $549.54 | $691.83 | $1,071.52 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $478.63 Median $602.56 Typical High $851.14 | Professional | AS · PA/NP assist | $478.63 | $602.56 | $851.14 |
CareSource Setting Facility Modifier None Typical Low $4,897.79 Median $4,897.79 Typical High $4,897.79 | Facility | None | $4,897.79 | $4,897.79 | $4,897.79 |
Cigna Setting Professional Modifier None Typical Low $4,786.30 Median $6,918.31 Typical High $10,000.00 | Professional | None | $4,786.30 | $6,918.31 | $10,000.00 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $912.01 Median $6,165.95 Typical High $12,302.69 | Facility | None | $912.01 | $6,165.95 | $12,302.69 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $4,897.79 Median $6,025.60 Typical High $8,912.51 | Professional | None | $4,897.79 | $6,025.60 | $8,912.51 |
United Setting Facility Modifier None Typical Low $302.00 Median $2,290.87 Typical High $10,232.93 | Facility | None | $302.00 | $2,290.87 | $10,232.93 |
United Setting Professional Modifier None Typical Low $3,548.13 Median $5,128.61 Typical High $8,128.31 | Professional | None | $3,548.13 | $5,128.61 | $8,128.31 |
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 $2,290.87 Median $2,290.87 Typical High $2,884.03 | Professional | 52 · Reduced service | $2,290.87 | $2,290.87 | $2,884.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $912.01 Median $912.01 Typical High $1,148.15 | Professional | 53 · Discontinued | $912.01 | $912.01 | $1,148.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $3,388.44 Median $3,388.44 Typical High $4,265.80 | Professional | 54 · Surgery only | $3,388.44 | $3,388.44 | $4,265.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $676.08 Median $676.08 Typical High $851.14 | Professional | 55 · Aftercare only | $676.08 | $676.08 | $851.14 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $457.09 Median $457.09 Typical High $575.44 | Professional | 56 · Pre-op care only | $457.09 | $457.09 | $575.44 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $3,162.28 Median $3,162.28 Typical High $3,981.07 | Professional | 78 · Unplanned return to OR | $3,162.28 | $3,162.28 | $3,981.07 |
Where Indiana sits
The same service costs 8.4 times more in Wisconsin than in Texas. 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 $28,671TX $3,407
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.