How much rates vary
Facilitymedian $6,457 · 10th to 90th $1,175 to $19,498Professionalmedian $776 · 10th to 90th $589 to $1,202
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 $741.31 Median $3,548.13 Typical High $14,125.38 | Facility | None | $741.31 | $3,548.13 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $676.08 Median $741.31 Typical High $954.99 | Professional | None | $676.08 | $741.31 | $954.99 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,380.38 Median $10,964.78 Typical High $22,908.68 | Facility | None | $1,380.38 | $10,964.78 | $22,908.68 |
Anthem BCBS Setting Professional Modifier None Typical Low $549.54 Median $776.25 Typical High $1,096.48 | Professional | None | $549.54 | $776.25 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $346.74 Median $478.63 Typical High $691.83 | Professional | 62 · Two surgeons | $346.74 | $478.63 | $691.83 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $87.10 Median $123.03 Typical High $186.21 | Professional | 80 · Assistant surgeon | $87.10 | $123.03 | $186.21 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $75.86 Median $107.15 Typical High $154.88 | Professional | AS · PA/NP assist | $75.86 | $107.15 | $154.88 |
CareSource Setting Facility Modifier None Typical Low $676.08 Median $676.08 Typical High $6,309.57 | Facility | None | $676.08 | $676.08 | $6,309.57 |
Cigna Setting Facility Modifier None Typical Low $776.25 Median $4,786.30 Typical High $6,918.31 | Facility | None | $776.25 | $4,786.30 | $6,918.31 |
Cigna Setting Professional Modifier None Typical Low $676.08 Median $891.25 Typical High $1,513.56 | Professional | None | $676.08 | $891.25 | $1,513.56 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $1,659.59 Median $6,456.54 Typical High $8,317.64 | Facility | None | $1,659.59 | $6,456.54 | $8,317.64 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $676.08 Median $812.83 Typical High $1,096.48 | Professional | None | $676.08 | $812.83 | $1,096.48 |
United Setting Facility Modifier None Typical Low $1,230.27 Median $5,128.61 Typical High $14,454.40 | Facility | None | $1,230.27 | $5,128.61 | $14,454.40 |
United Setting Professional Modifier None Typical Low $630.96 Median $912.01 Typical High $1,288.25 | Professional | None | $630.96 | $912.01 | $1,288.25 |
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 $331.13 Median $371.54 Typical High $407.38 | Professional | 52 · Reduced service | $331.13 | $371.54 | $407.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $134.90 Median $147.91 Typical High $165.96 | Professional | 53 · Discontinued | $134.90 | $147.91 | $165.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $501.19 Median $549.54 Typical High $616.60 | Professional | 54 · Surgery only | $501.19 | $549.54 | $616.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $100.00 Median $109.65 Typical High $123.03 | Professional | 55 · Aftercare only | $100.00 | $109.65 | $123.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $67.61 Median $74.13 Typical High $83.18 | Professional | 56 · Pre-op care only | $67.61 | $74.13 | $83.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $467.74 Median $512.86 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $467.74 | $512.86 | $575.44 |
Where Indiana sits
The same service costs 5.3 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 $10,556MT $2,002
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.