How much rates vary
Facilitymedian $4,365 · 10th to 90th $1,175 to $14,125Professionalmedian $851 · 10th to 90th $661 to $1,288
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 $758.58 Median $3,548.13 Typical High $14,125.38 | Facility | None | $758.58 | $3,548.13 | $14,125.38 |
Aetna Setting Professional Modifier None Typical Low $758.58 Median $758.58 Typical High $1,023.29 | Professional | None | $758.58 | $758.58 | $1,023.29 |
Ambetter Setting Professional Modifier None Typical Low $660.69 Median $660.69 Typical High $660.69 | Professional | None | $660.69 | $660.69 | $660.69 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,288.25 Median $7,413.10 Typical High $17,378.01 | Facility | None | $1,288.25 | $7,413.10 | $17,378.01 |
Anthem BCBS Setting Professional Modifier None Typical Low $660.69 Median $851.14 Typical High $1,148.15 | Professional | None | $660.69 | $851.14 | $1,148.15 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,000.00 Median $1,288.25 Typical High $1,737.80 | Professional | 50 · Both sides | $1,000.00 | $1,288.25 | $1,737.80 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $416.87 Median $537.03 Typical High $724.44 | Professional | 62 · Two surgeons | $416.87 | $537.03 | $724.44 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $107.15 Median $138.04 Typical High $194.98 | Professional | 80 · Assistant surgeon | $107.15 | $138.04 | $194.98 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $93.33 Median $120.23 Typical High $162.18 | Professional | AS · PA/NP assist | $93.33 | $120.23 | $162.18 |
CareSource Setting Facility Modifier None Typical Low $794.33 Median $794.33 Typical High $3,311.31 | Facility | None | $794.33 | $794.33 | $3,311.31 |
Cigna Setting Facility Modifier None Typical Low $776.25 Median $2,570.40 Typical High $3,715.35 | Facility | None | $776.25 | $2,570.40 | $3,715.35 |
Cigna Setting Professional Modifier None Typical Low $537.03 Median $831.76 Typical High $1,288.25 | Professional | None | $537.03 | $831.76 | $1,288.25 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $1,905.46 Median $2,951.21 Typical High $5,495.41 | Facility | None | $1,905.46 | $2,951.21 | $5,495.41 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $891.25 Median $1,174.90 Typical High $1,479.11 | Professional | None | $891.25 | $1,174.90 | $1,479.11 |
United Setting Facility Modifier None Typical Low $870.96 Median $4,168.69 Typical High $9,120.11 | Facility | None | $870.96 | $4,168.69 | $9,120.11 |
United Setting Professional Modifier None Typical Low $660.69 Median $831.76 Typical High $1,412.54 | Professional | None | $660.69 | $831.76 | $1,412.54 |
6 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 $380.19 Median $380.19 Typical High $446.68 | Professional | 52 · Reduced service | $380.19 | $380.19 | $446.68 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $151.36 Median $151.36 Typical High $181.97 | Professional | 53 · Discontinued | $151.36 | $151.36 | $181.97 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $575.44 Median $575.44 Typical High $676.08 | Professional | 54 · Surgery only | $575.44 | $575.44 | $676.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $114.82 Median $114.82 Typical High $134.90 | Professional | 55 · Aftercare only | $114.82 | $114.82 | $134.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $75.86 Typical High $89.13 | Professional | 56 · Pre-op care only | $75.86 | $75.86 | $89.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $537.03 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $537.03 | $537.03 | $630.96 |
Where Indiana sits
The same service costs 3.6 times more in Vermont 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
VT $8,561MT $2,405
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.