How much rates vary
Facilitymedian $2,692 · 10th to 90th $676 to $6,310Professionalmedian $741 · 10th to 90th $562 to $1,096
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 Facility Modifier None Typical Low $660.69 Median $676.08 Typical High $676.08 | Facility | None | $660.69 | $676.08 | $676.08 |
Aetna Setting Professional Modifier None Typical Low $562.34 Median $676.08 Typical High $1,071.52 | Professional | None | $562.34 | $676.08 | $1,071.52 |
Anthem BCBS Setting Professional Modifier None Typical Low $562.34 Median $758.58 Typical High $1,122.02 | Professional | None | $562.34 | $758.58 | $1,122.02 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $831.76 Median $1,071.52 Typical High $1,621.81 | Professional | 50 · Both sides | $831.76 | $1,071.52 | $1,621.81 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $346.74 Median $457.09 Typical High $691.83 | Professional | 62 · Two surgeons | $346.74 | $457.09 | $691.83 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $89.13 Median $114.82 Typical High $173.78 | Professional | 80 · Assistant surgeon | $89.13 | $114.82 | $173.78 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $77.62 Median $100.00 Typical High $151.36 | Professional | AS · PA/NP assist | $77.62 | $100.00 | $151.36 |
Cigna Setting Facility Modifier None Typical Low $1,584.89 Median $4,073.80 Typical High $5,495.41 | Facility | None | $1,584.89 | $4,073.80 | $5,495.41 |
Cigna Setting Professional Modifier None Typical Low $630.96 Median $812.83 Typical High $1,258.93 | Professional | None | $630.96 | $812.83 | $1,258.93 |
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 $562.34 Median $776.25 Typical High $1,122.02 | Professional | None | $562.34 | $776.25 | $1,122.02 |
Martin's Point Setting Facility Modifier None Typical Low $660.69 Median $660.69 Typical High $676.08 | Facility | None | $660.69 | $660.69 | $676.08 |
Martin's Point Setting Professional Modifier None Typical Low $575.44 Median $676.08 Typical High $1,071.52 | Professional | None | $575.44 | $676.08 | $1,071.52 |
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 $549.54 Median $776.25 Typical High $1,122.02 | Professional | None | $549.54 | $776.25 | $1,122.02 |
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 $288.40 Median $338.84 Typical High $338.84 | Professional | 52 · Reduced service | $288.40 | $338.84 | $338.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $114.82 Median $134.90 Typical High $134.90 | Professional | 53 · Discontinued | $114.82 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $436.52 Median $501.19 Typical High $501.19 | Professional | 54 · Surgery only | $436.52 | $501.19 | $501.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $87.10 Median $100.00 Typical High $100.00 | Professional | 55 · Aftercare only | $87.10 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $57.54 Median $67.61 Typical High $67.61 | Professional | 56 · Pre-op care only | $57.54 | $67.61 | $67.61 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $407.38 Median $467.74 Typical High $467.74 | Professional | 78 · Unplanned return to OR | $407.38 | $467.74 | $467.74 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $331.13 Median $338.84 Typical High $338.84 | Professional | 52 · Reduced service | $331.13 | $338.84 | $338.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $131.83 Median $134.90 Typical High $134.90 | Professional | 53 · Discontinued | $131.83 | $134.90 | $134.90 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $489.78 Median $501.19 Typical High $501.19 | Professional | 54 · Surgery only | $489.78 | $501.19 | $501.19 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $97.72 Median $100.00 Typical High $100.00 | Professional | 55 · Aftercare only | $97.72 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $66.07 Median $67.61 Typical High $67.61 | Professional | 56 · Pre-op care only | $66.07 | $67.61 | $67.61 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $457.09 Median $467.74 Typical High $467.74 | Professional | 78 · Unplanned return to OR | $457.09 | $467.74 | $467.74 |
Where Maine sits
The same service costs 6.0 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 $11,096MT $1,846
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.