How much rates vary
Facilitymedian $2,512 · 10th to 90th $1,000 to $5,754Professionalmedian $832 · 10th to 90th $631 to $1,230
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 $776.25 Typical High $776.25 | Professional | None | $645.65 | $776.25 | $776.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $630.96 Median $851.14 Typical High $1,230.27 | Professional | None | $630.96 | $851.14 | $1,230.27 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $389.05 Median $512.86 Typical High $776.25 | Professional | 62 · Two surgeons | $389.05 | $512.86 | $776.25 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $97.72 Median $128.82 Typical High $194.98 | Professional | 80 · Assistant surgeon | $97.72 | $128.82 | $194.98 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $87.10 Median $112.20 Typical High $169.82 | Professional | AS · PA/NP assist | $87.10 | $112.20 | $169.82 |
Cigna Setting Facility Modifier None Typical Low $1,000.00 Median $3,388.44 Typical High $5,495.41 | Facility | None | $1,000.00 | $3,388.44 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $707.95 Median $912.01 Typical High $1,412.54 | Professional | None | $707.95 | $912.01 | $1,412.54 |
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 $630.96 Median $870.96 Typical High $1,230.27 | Professional | None | $630.96 | $870.96 | $1,230.27 |
Martin's Point Setting Professional Modifier None Typical Low $645.65 Median $776.25 Typical High $776.25 | Professional | None | $645.65 | $776.25 | $776.25 |
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 $630.96 Median $891.25 Typical High $1,258.93 | Professional | None | $630.96 | $891.25 | $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 $323.59 Median $380.19 Typical High $380.19 | Professional | 52 · Reduced service | $323.59 | $380.19 | $380.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $131.83 Median $154.88 Typical High $154.88 | Professional | 53 · Discontinued | $131.83 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $489.78 Median $575.44 Typical High $575.44 | Professional | 54 · Surgery only | $489.78 | $575.44 | $575.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $97.72 Median $114.82 Typical High $114.82 | Professional | 55 · Aftercare only | $97.72 | $114.82 | $114.82 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $64.57 Median $77.62 Typical High $77.62 | Professional | 56 · Pre-op care only | $64.57 | $77.62 | $77.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $457.09 Median $537.03 Typical High $537.03 | Professional | 78 · Unplanned return to OR | $457.09 | $537.03 | $537.03 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $371.54 Median $380.19 Typical High $380.19 | Professional | 52 · Reduced service | $371.54 | $380.19 | $380.19 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $154.88 Typical High $154.88 | Professional | 53 · Discontinued | $147.91 | $154.88 | $154.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $562.34 Median $575.44 Typical High $575.44 | Professional | 54 · Surgery only | $562.34 | $575.44 | $575.44 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $112.20 Median $114.82 Typical High $114.82 | Professional | 55 · Aftercare only | $112.20 | $114.82 | $114.82 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $74.13 Median $77.62 Typical High $77.62 | Professional | 56 · Pre-op care only | $74.13 | $77.62 | $77.62 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $524.81 Median $537.03 Typical High $537.03 | Professional | 78 · Unplanned return to OR | $524.81 | $537.03 | $537.03 |
Where Maine sits
The same service costs 5.4 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 $11,084MT $2,070
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.