How much rates vary
Facilitymedian $1,072 · 10th to 90th $389 to $2,291Professionalmedian $479 · 10th to 90th $331 to $776
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 $389.05 Median $389.05 Typical High $602.56 | Facility | None | $389.05 | $389.05 | $602.56 |
Aetna Setting Professional Modifier None Typical Low $389.05 Median $562.34 Typical High $776.25 | Professional | None | $389.05 | $562.34 | $776.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $302.00 Median $416.87 Typical High $602.56 | Professional | None | $302.00 | $416.87 | $602.56 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $1,174.90 Typical High $2,290.87 | Facility | None | $812.83 | $1,174.90 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $407.38 Median $602.56 Typical High $724.44 | Professional | None | $407.38 | $602.56 | $724.44 |
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 $346.74 Median $537.03 Typical High $891.25 | Professional | None | $346.74 | $537.03 | $891.25 |
Martin's Point Setting Professional Modifier None Typical Low $389.05 Median $575.44 Typical High $776.25 | Professional | None | $389.05 | $575.44 | $776.25 |
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 $316.23 Median $478.63 Typical High $794.33 | Professional | None | $316.23 | $478.63 | $794.33 |
13 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 $194.98 Median $194.98 Typical High $302.00 | Professional | 52 · Reduced service | $194.98 | $194.98 | $302.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $77.62 Median $77.62 Typical High $120.23 | Professional | 53 · Discontinued | $77.62 | $77.62 | $120.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $295.12 Median $295.12 Typical High $446.68 | Professional | 54 · Surgery only | $295.12 | $295.12 | $446.68 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $58.88 Median $58.88 Typical High $91.20 | Professional | 55 · Aftercare only | $58.88 | $58.88 | $91.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $38.90 Median $38.90 Typical High $60.26 | Professional | 56 · Pre-op care only | $38.90 | $38.90 | $60.26 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $275.42 Median $275.42 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $275.42 | $275.42 | $416.87 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $457.09 Median $630.96 Typical High $891.25 | Professional | 50 · Both sides | $457.09 | $630.96 | $891.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $194.98 Median $194.98 Typical High $302.00 | Professional | 52 · Reduced service | $194.98 | $194.98 | $302.00 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $77.62 Median $77.62 Typical High $120.23 | Professional | 53 · Discontinued | $77.62 | $77.62 | $120.23 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $295.12 Median $295.12 Typical High $446.68 | Professional | 54 · Surgery only | $295.12 | $295.12 | $446.68 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $58.88 Median $58.88 Typical High $91.20 | Professional | 55 · Aftercare only | $58.88 | $58.88 | $91.20 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $38.90 Median $38.90 Typical High $60.26 | Professional | 56 · Pre-op care only | $38.90 | $38.90 | $60.26 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $275.42 Median $275.42 Typical High $416.87 | Professional | 78 · Unplanned return to OR | $275.42 | $275.42 | $416.87 |
Where Maine sits
The same service costs 5.2 times more in Colorado than in West Virginia. 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 $4,833WV $936
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.