How much rates vary
Facilitymedian $2,239 · 10th to 90th $813 to $3,890Professionalmedian $1,318 · 10th to 90th $891 to $1,698
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 $1,258.93 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,258.93 | $1,412.54 | $1,412.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $851.14 Median $1,230.27 Typical High $1,737.80 | Professional | None | $851.14 | $1,230.27 | $1,737.80 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,288.25 Median $1,819.70 Typical High $2,630.27 | Professional | 50 · Both sides | $1,288.25 | $1,819.70 | $2,630.27 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $537.03 Median $776.25 Typical High $1,096.48 | Professional | 62 · Two surgeons | $537.03 | $776.25 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $134.90 Median $194.98 Typical High $275.42 | Professional | 80 · Assistant surgeon | $134.90 | $194.98 | $275.42 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $120.23 Median $169.82 Typical High $245.47 | Professional | AS · PA/NP assist | $120.23 | $169.82 | $245.47 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $2,290.87 Typical High $3,090.30 | Facility | None | $812.83 | $2,290.87 | $3,090.30 |
Cigna Setting Professional Modifier None Typical Low $1,122.02 Median $1,412.54 Typical High $1,819.70 | Professional | None | $1,122.02 | $1,412.54 | $1,819.70 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $933.25 Median $1,202.26 Typical High $1,548.82 | Professional | None | $933.25 | $1,202.26 | $1,548.82 |
Martin's Point Setting Professional Modifier None Typical Low $1,258.93 Median $1,412.54 Typical High $1,412.54 | Professional | None | $1,258.93 | $1,412.54 | $1,412.54 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
United Setting Professional Modifier None Typical Low $891.25 Median $1,288.25 Typical High $1,659.59 | Professional | None | $891.25 | $1,288.25 | $1,659.59 |
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 $707.95 Median $707.95 Typical High $707.95 | Professional | 52 · Reduced service | $707.95 | $707.95 | $707.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | 53 · Discontinued | $281.84 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,071.52 Typical High $1,071.52 | Professional | 54 · Surgery only | $1,071.52 | $1,071.52 | $1,071.52 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $213.80 Typical High $213.80 | Professional | 55 · Aftercare only | $213.80 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | 56 · Pre-op care only | $141.25 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,000.00 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $707.95 Median $707.95 Typical High $707.95 | Professional | 52 · Reduced service | $707.95 | $707.95 | $707.95 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | 53 · Discontinued | $281.84 | $281.84 | $281.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,071.52 Median $1,071.52 Typical High $1,071.52 | Professional | 54 · Surgery only | $1,071.52 | $1,071.52 | $1,071.52 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $213.80 Median $213.80 Typical High $213.80 | Professional | 55 · Aftercare only | $213.80 | $213.80 | $213.80 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $141.25 Median $141.25 Typical High $141.25 | Professional | 56 · Pre-op care only | $141.25 | $141.25 | $141.25 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,000.00 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,000.00 | $1,000.00 |
Where Maine sits
The same service costs 3.1 times more in Wisconsin than in Florida. 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 $8,254FL $2,626
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.