How much rates vary
Facilitymedian $2,692 · 10th to 90th $1,514 to $7,586Professionalmedian $1,585 · 10th to 90th $1,259 to $2,455
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 $1,513.56 Median $1,513.56 Typical High $1,513.56 | Facility | None | $1,513.56 | $1,513.56 | $1,513.56 |
Aetna Setting Professional Modifier None Typical Low $1,258.93 Median $1,513.56 Typical High $1,949.84 | Professional | None | $1,258.93 | $1,513.56 | $1,949.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,258.93 Median $1,737.80 Typical High $2,511.89 | Professional | None | $1,258.93 | $1,737.80 | $2,511.89 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,905.46 Median $2,630.27 Typical High $3,715.35 | Professional | 50 · Both sides | $1,905.46 | $2,630.27 | $3,715.35 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $794.33 Median $1,096.48 Typical High $1,584.89 | Professional | 62 · Two surgeons | $794.33 | $1,096.48 | $1,584.89 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $204.17 Median $263.03 Typical High $398.11 | Professional | 80 · Assistant surgeon | $204.17 | $263.03 | $398.11 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $177.83 Median $245.47 Typical High $346.74 | Professional | AS · PA/NP assist | $177.83 | $245.47 | $346.74 |
Cigna Setting Facility Modifier None Typical Low $2,137.96 Median $5,011.87 Typical High $7,585.78 | Facility | None | $2,137.96 | $5,011.87 | $7,585.78 |
Cigna Setting Professional Modifier None Typical Low $1,445.44 Median $1,584.89 Typical High $2,454.71 | Professional | None | $1,445.44 | $1,584.89 | $2,454.71 |
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 $1,258.93 Median $1,621.81 Typical High $2,344.23 | Professional | None | $1,258.93 | $1,621.81 | $2,344.23 |
Martin's Point Setting Professional Modifier None Typical Low $1,288.25 Median $1,513.56 Typical High $1,949.84 | Professional | None | $1,288.25 | $1,513.56 | $1,949.84 |
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 $1,230.27 Median $1,621.81 Typical High $2,187.76 | Professional | None | $1,230.27 | $1,621.81 | $2,187.76 |
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 $660.69 Median $741.31 Typical High $741.31 | Professional | 52 · Reduced service | $660.69 | $741.31 | $741.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $302.00 Typical High $302.00 | Professional | 53 · Discontinued | $263.03 | $302.00 | $302.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,122.02 Typical High $1,122.02 | Professional | 54 · Surgery only | $1,000.00 | $1,122.02 | $1,122.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $199.53 Median $223.87 Typical High $223.87 | Professional | 55 · Aftercare only | $199.53 | $223.87 | $223.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $131.83 Median $151.36 Typical High $151.36 | Professional | 56 · Pre-op care only | $131.83 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $933.25 Median $1,047.13 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $933.25 | $1,047.13 | $1,047.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $724.44 Median $741.31 Typical High $741.31 | Professional | 52 · Reduced service | $724.44 | $741.31 | $741.31 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $302.00 Typical High $302.00 | Professional | 53 · Discontinued | $295.12 | $302.00 | $302.00 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,122.02 Typical High $1,122.02 | Professional | 54 · Surgery only | $1,096.48 | $1,122.02 | $1,122.02 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $218.78 Median $223.87 Typical High $223.87 | Professional | 55 · Aftercare only | $218.78 | $223.87 | $223.87 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $147.91 Median $151.36 Typical High $151.36 | Professional | 56 · Pre-op care only | $147.91 | $151.36 | $151.36 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $1,047.13 Typical High $1,047.13 | Professional | 78 · Unplanned return to OR | $1,023.29 | $1,047.13 | $1,047.13 |
Where Maine sits
The same service costs 4.7 times more in Colorado than in Kentucky. 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 $15,002KY $3,224
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.