How much rates vary
Facilitymedian $5,495 · 10th to 90th $832 to $19,498Professionalmedian $1,202 · 10th to 90th $871 to $1,738
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 $977.24 Median $5,011.87 Typical High $7,244.36 | Facility | None | $977.24 | $5,011.87 | $7,244.36 |
Aetna Setting Professional Modifier None Typical Low $912.01 Median $977.24 Typical High $1,122.02 | Professional | None | $912.01 | $977.24 | $1,122.02 |
Anthem BCBS Setting Facility Modifier None Typical Low $794.33 Median $10,964.78 Typical High $22,908.68 | Facility | None | $794.33 | $10,964.78 | $22,908.68 |
Anthem BCBS Setting Professional Modifier None Typical Low $870.96 Median $1,202.26 Typical High $1,584.89 | Professional | None | $870.96 | $1,202.26 | $1,584.89 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $549.54 Median $758.58 Typical High $1,000.00 | Professional | 62 · Two surgeons | $549.54 | $758.58 | $1,000.00 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $138.04 Median $194.98 Typical High $269.15 | Professional | 80 · Assistant surgeon | $138.04 | $194.98 | $269.15 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $120.23 Median $169.82 Typical High $223.87 | Professional | AS · PA/NP assist | $120.23 | $169.82 | $223.87 |
CareSource Setting Facility Modifier None Typical Low $1,071.52 Median $1,071.52 Typical High $6,456.54 | Facility | None | $1,071.52 | $1,071.52 | $6,456.54 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $2,818.38 Typical High $4,677.35 | Facility | None | $549.54 | $2,818.38 | $4,677.35 |
Cigna Setting Professional Modifier None Typical Low $977.24 Median $1,258.93 Typical High $6,025.60 | Professional | None | $977.24 | $1,258.93 | $6,025.60 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $1,445.44 Median $5,495.41 Typical High $9,332.54 | Facility | None | $1,445.44 | $5,495.41 | $9,332.54 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $1,000.00 Median $1,445.44 Typical High $1,905.46 | Professional | None | $1,000.00 | $1,445.44 | $1,905.46 |
United Setting Facility Modifier None Typical Low $1,202.26 Median $4,570.88 Typical High $12,022.64 | Facility | None | $1,202.26 | $4,570.88 | $12,022.64 |
United Setting Professional Modifier None Typical Low $851.14 Median $1,122.02 Typical High $1,862.09 | Professional | None | $851.14 | $1,122.02 | $1,862.09 |
7 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 $457.09 Median $489.78 Typical High $537.03 | Professional | 52 · Reduced service | $457.09 | $489.78 | $537.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $181.97 Median $194.98 Typical High $213.80 | Professional | 53 · Discontinued | $181.97 | $194.98 | $213.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $691.83 Median $724.44 Typical High $794.33 | Professional | 54 · Surgery only | $691.83 | $724.44 | $794.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $138.04 Median $147.91 Typical High $158.49 | Professional | 55 · Aftercare only | $138.04 | $147.91 | $158.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $91.20 Median $97.72 Typical High $107.15 | Professional | 56 · Pre-op care only | $91.20 | $97.72 | $107.15 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $645.65 Median $676.08 Typical High $741.31 | Professional | 78 · Unplanned return to OR | $645.65 | $676.08 | $741.31 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $912.01 Median $912.01 Typical High $912.01 | Professional | 59 · Distinct service | $912.01 | $912.01 | $912.01 |
Where Indiana sits
The same service costs 5.3 times more in Vermont than in Hawaii. 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
VT $13,652HI $2,577
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.