How much rates vary
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 $204.17 Median $3,235.94 Typical High $8,912.51 | Facility | None | $204.17 | $3,235.94 | $8,912.51 |
Aetna Setting Professional Modifier None Typical Low $123.03 Median $194.98 Typical High $257.04 | Professional | None | $123.03 | $194.98 | $257.04 |
Anthem BCBS Setting Facility Modifier None Typical Low $2,137.96 Median $3,311.31 Typical High $5,370.32 | Facility | None | $2,137.96 | $3,311.31 | $5,370.32 |
Anthem BCBS Setting Professional Modifier None Typical Low $144.54 Median $234.42 Typical High $416.87 | Professional | None | $144.54 | $234.42 | $416.87 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $1,698.24 | Facility | None | $50.12 | $66.07 | $1,698.24 |
Cigna Setting Professional Modifier None Typical Low $144.54 Median $213.80 Typical High $338.84 | Professional | None | $144.54 | $213.80 | $338.84 |
Denver HMP Setting Facility Modifier None Typical Low $123.03 Median $204.17 Typical High $363.08 | Facility | None | $123.03 | $204.17 | $363.08 |
Kaiser Permanente Setting Professional Modifier None Typical Low $131.83 Median $218.78 Typical High $371.54 | Professional | None | $131.83 | $218.78 | $371.54 |
Select Health Setting Facility Modifier None Typical Low $218.78 Median $239.88 Typical High $457.09 | Facility | None | $218.78 | $239.88 | $457.09 |
Select Health Setting Professional Modifier None Typical Low $83.18 Median $218.78 Typical High $426.58 | Professional | None | $83.18 | $218.78 | $426.58 |
United Setting Facility Modifier None Typical Low $676.08 Median $1,412.54 Typical High $4,897.79 | Facility | None | $676.08 | $1,412.54 | $4,897.79 |
United Setting Professional Modifier None Typical Low $144.54 Median $229.09 Typical High $389.05 | Professional | None | $144.54 | $229.09 | $389.05 |
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 $61.66 Median $91.20 Typical High $102.33 | Professional | 52 · Reduced service | $61.66 | $91.20 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $36.31 Typical High $40.74 | Professional | 53 · Discontinued | $24.55 | $36.31 | $40.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $138.04 Typical High $154.88 | Professional | 54 · Surgery only | $91.20 | $138.04 | $154.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $27.54 Typical High $30.90 | Professional | 55 · Aftercare only | $18.62 | $27.54 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $18.20 Typical High $20.42 | Professional | 56 · Pre-op care only | $12.30 | $18.20 | $20.42 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $85.11 Median $128.82 Typical High $144.54 | Professional | 78 · Unplanned return to OR | $85.11 | $128.82 | $144.54 |
Where Colorado sits
The same service costs 3.8 times more in Wisconsin 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.
Colorado· 16th of 51
$263
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.