How much rates vary
Facilitymedian $2,754 · 10th to 90th $2,138 to $8,913Professionalmedian $1,445 · 10th to 90th $1,175 to $2,344
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 $1,174.90 Median $1,380.38 Typical High $1,380.38 | Professional | None | $1,174.90 | $1,380.38 | $1,380.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,202.26 Median $1,621.81 Typical High $2,344.23 | Professional | None | $1,202.26 | $1,621.81 | $2,344.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $758.58 Median $1,023.29 Typical High $1,479.11 | Professional | 62 · Two surgeons | $758.58 | $1,023.29 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $190.55 Median $263.03 Typical High $371.54 | Professional | 80 · Assistant surgeon | $190.55 | $263.03 | $371.54 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $165.96 Median $229.09 Typical High $323.59 | Professional | AS · PA/NP assist | $165.96 | $229.09 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $2,137.96 Median $5,011.87 Typical High $6,606.93 | Facility | None | $2,137.96 | $5,011.87 | $6,606.93 |
Cigna Setting Professional Modifier None Typical Low $1,318.26 Median $1,445.44 Typical High $2,290.87 | Professional | None | $1,318.26 | $1,445.44 | $2,290.87 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $8,912.51 | Facility | None | $2,137.96 | $2,691.53 | $8,912.51 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,148.15 Median $1,479.11 Typical High $2,290.87 | Professional | None | $1,148.15 | $1,479.11 | $2,290.87 |
Martin's Point Setting Professional Modifier None Typical Low $1,174.90 Median $1,380.38 Typical High $1,380.38 | Professional | None | $1,174.90 | $1,380.38 | $1,380.38 |
United Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $8,912.51 | Facility | None | $2,137.96 | $2,691.53 | $8,912.51 |
United Setting Professional Modifier None Typical Low $1,096.48 Median $1,479.11 Typical High $1,995.26 | Professional | None | $1,096.48 | $1,479.11 | $1,995.26 |
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 $602.56 Median $676.08 Typical High $676.08 | Professional | 52 · Reduced service | $602.56 | $676.08 | $676.08 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $275.42 Typical High $275.42 | Professional | 53 · Discontinued | $239.88 | $275.42 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $912.01 Median $1,023.29 Typical High $1,023.29 | Professional | 54 · Surgery only | $912.01 | $1,023.29 | $1,023.29 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $204.17 Typical High $204.17 | Professional | 55 · Aftercare only | $181.97 | $204.17 | $204.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $138.04 Typical High $138.04 | Professional | 56 · Pre-op care only | $120.23 | $138.04 | $138.04 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $851.14 Median $954.99 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $851.14 | $954.99 | $954.99 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $676.08 Median $676.08 Typical High $676.08 | Professional | 52 · Reduced service | $676.08 | $676.08 | $676.08 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $269.15 Median $275.42 Typical High $275.42 | Professional | 53 · Discontinued | $269.15 | $275.42 | $275.42 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,023.29 Median $1,023.29 Typical High $1,023.29 | Professional | 54 · Surgery only | $1,023.29 | $1,023.29 | $1,023.29 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | 55 · Aftercare only | $204.17 | $204.17 | $204.17 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $134.90 Median $138.04 Typical High $138.04 | Professional | 56 · Pre-op care only | $134.90 | $138.04 | $138.04 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $954.99 Median $954.99 Typical High $954.99 | Professional | 78 · Unplanned return to OR | $954.99 | $954.99 | $954.99 |
Where Maine sits
The same service costs 5.5 times more in Colorado than in West Virginia. 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 $14,842WV $2,709
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.