How much rates vary
Facilitymedian $1,778 · 10th to 90th $537 to $3,311Professionalmedian $355 · 10th to 90th $269 to $513
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 $269.15 Median $354.81 Typical High $354.81 | Professional | None | $269.15 | $354.81 | $354.81 |
Anthem BCBS Setting Professional Modifier None Typical Low $269.15 Median $346.74 Typical High $512.86 | Professional | None | $269.15 | $346.74 | $512.86 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $398.11 Median $524.81 Typical High $776.25 | Professional | 50 · Both sides | $398.11 | $524.81 | $776.25 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $165.96 Median $218.78 Typical High $323.59 | Professional | 62 · Two surgeons | $165.96 | $218.78 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,819.70 Typical High $2,951.21 | Facility | None | $537.03 | $1,819.70 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $309.03 Median $380.19 Typical High $575.44 | Professional | None | $309.03 | $380.19 | $575.44 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $275.42 Median $354.81 Typical High $489.78 | Professional | None | $275.42 | $354.81 | $489.78 |
Martin's Point Setting Professional Modifier None Typical Low $269.15 Median $354.81 Typical High $354.81 | Professional | None | $269.15 | $354.81 | $354.81 |
United Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
United Setting Professional Modifier None Typical Low $269.15 Median $354.81 Typical High $478.63 | Professional | None | $269.15 | $354.81 | $478.63 |
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 $144.54 Median $173.78 Typical High $173.78 | Professional | 52 · Reduced service | $144.54 | $173.78 | $173.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $57.54 Median $70.79 Typical High $70.79 | Professional | 53 · Discontinued | $57.54 | $70.79 | $70.79 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $213.80 Median $263.03 Typical High $263.03 | Professional | 54 · Surgery only | $213.80 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $42.66 Median $52.48 Typical High $52.48 | Professional | 55 · Aftercare only | $42.66 | $52.48 | $52.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.84 Median $35.48 Typical High $35.48 | Professional | 56 · Pre-op care only | $28.84 | $35.48 | $35.48 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $199.53 Median $245.47 Typical High $245.47 | Professional | 78 · Unplanned return to OR | $199.53 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $162.18 Median $173.78 Typical High $173.78 | Professional | 52 · Reduced service | $162.18 | $173.78 | $173.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $64.57 Median $70.79 Typical High $70.79 | Professional | 53 · Discontinued | $64.57 | $70.79 | $70.79 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $239.88 Median $263.03 Typical High $263.03 | Professional | 54 · Surgery only | $239.88 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $48.98 Median $52.48 Typical High $52.48 | Professional | 55 · Aftercare only | $48.98 | $52.48 | $52.48 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $32.36 Median $35.48 Typical High $35.48 | Professional | 56 · Pre-op care only | $32.36 | $35.48 | $35.48 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $223.87 Median $245.47 Typical High $245.47 | Professional | 78 · Unplanned return to OR | $223.87 | $245.47 | $245.47 |
Where Maine sits
The same service costs 7.3 times more in Colorado 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
CO $6,269MT $863
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.