How much rates vary
Facilitymedian $1,950 · 10th to 90th $117 to $4,898Professionalmedian $100 · 10th to 90th $72 to $200
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 $95.50 Median $1,230.27 Typical High $7,413.10 | Facility | None | $95.50 | $1,230.27 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $83.18 Median $100.00 Typical High $204.17 | Professional | None | $83.18 | $100.00 | $204.17 |
Ambetter Setting Professional Modifier None Typical Low $109.65 Median $144.54 Typical High $251.19 | Professional | None | $109.65 | $144.54 | $251.19 |
Anthem BCBS Setting Facility Modifier None Typical Low $933.25 Median $3,162.28 Typical High $4,897.79 | Facility | None | $933.25 | $3,162.28 | $4,897.79 |
Anthem BCBS Setting Professional Modifier None Typical Low $85.11 Median $100.00 Typical High $199.53 | Professional | None | $85.11 | $100.00 | $199.53 |
CDPHP Setting Facility Modifier None Typical Low $1,348.96 Median $1,348.96 Typical High $4,073.80 | Facility | None | $1,348.96 | $1,348.96 | $4,073.80 |
CDPHP Setting Professional Modifier None Typical Low $144.54 Median $144.54 Typical High $173.78 | Professional | None | $144.54 | $144.54 | $173.78 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $162.18 Typical High $331.13 | Facility | None | $100.00 | $162.18 | $331.13 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $128.82 Typical High $213.80 | Professional | None | $79.43 | $128.82 | $213.80 |
Emblem Health Setting Facility Modifier None Typical Low $72.44 Median $117.49 Typical High $389.05 | Facility | None | $72.44 | $117.49 | $389.05 |
Emblem Health Setting Professional Modifier None Typical Low $8.13 Median $81.28 Typical High $95.50 | Professional | None | $8.13 | $81.28 | $95.50 |
Excellus BCBS Setting Professional Modifier None Typical Low $72.44 Median $104.71 Typical High $147.91 | Professional | None | $72.44 | $104.71 | $147.91 |
Highmark BCBS Setting Facility Modifier None Typical Low $204.17 Median $346.74 Typical High $954.99 | Facility | None | $204.17 | $346.74 | $954.99 |
Highmark BCBS Setting Professional Modifier None Typical Low $123.03 Median $144.54 Typical High $251.19 | Professional | None | $123.03 | $144.54 | $251.19 |
MVP Health Care Setting Facility Modifier None Typical Low $93.33 Median $93.33 Typical High $93.33 | Facility | None | $93.33 | $93.33 | $93.33 |
MVP Health Care Setting Professional Modifier None Typical Low $50.12 Median $50.12 Typical High $218.78 | Professional | None | $50.12 | $50.12 | $218.78 |
United Setting Facility Modifier None Typical Low $363.08 Median $1,148.15 Typical High $4,365.16 | Facility | None | $363.08 | $1,148.15 | $4,365.16 |
United Setting Professional Modifier None Typical Low $66.07 Median $104.71 Typical High $199.53 | Professional | None | $66.07 | $104.71 | $199.53 |
Univera Setting Facility Modifier None Typical Low $79.43 Median $112.20 Typical High $269.15 | Facility | None | $79.43 | $112.20 | $269.15 |
Univera Setting Professional Modifier None Typical Low $79.43 Median $104.71 Typical High $147.91 | Professional | None | $79.43 | $104.71 | $147.91 |
15 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 $41.69 Median $50.12 Typical High $56.23 | Professional | 52 · Reduced service | $41.69 | $50.12 | $56.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $19.95 Typical High $22.39 | Professional | 53 · Discontinued | $16.60 | $19.95 | $22.39 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $74.13 Typical High $85.11 | Professional | 54 · Surgery only | $61.66 | $74.13 | $85.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $14.79 Typical High $16.98 | Professional | 55 · Aftercare only | $12.30 | $14.79 | $16.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $10.00 Typical High $11.22 | Professional | 56 · Pre-op care only | $8.32 | $10.00 | $11.22 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $57.54 Median $69.18 Typical High $79.43 | Professional | 78 · Unplanned return to OR | $57.54 | $69.18 | $79.43 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $109.65 Typical High $134.90 | Professional | 54 · Surgery only | $77.62 | $109.65 | $134.90 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $12.30 Typical High $14.79 | Professional | 55 · Aftercare only | $8.51 | $12.30 | $14.79 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $12.30 Typical High $14.79 | Professional | 56 · Pre-op care only | $8.51 | $12.30 | $14.79 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $97.72 Typical High $120.23 | Professional | 78 · Unplanned return to OR | $69.18 | $97.72 | $120.23 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $63.10 Median $77.62 Typical High $91.20 | Professional | 53 · Discontinued | $63.10 | $77.62 | $91.20 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $77.62 Median $109.65 Typical High $134.90 | Professional | 54 · Surgery only | $77.62 | $109.65 | $134.90 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $12.30 Typical High $16.98 | Professional | 55 · Aftercare only | $8.51 | $12.30 | $16.98 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $12.30 Typical High $16.98 | Professional | 56 · Pre-op care only | $8.51 | $12.30 | $16.98 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $69.18 Median $97.72 Typical High $120.23 | Professional | 78 · Unplanned return to OR | $69.18 | $97.72 | $120.23 |
Where New York sits
The same service costs 4.4 times more in Alaska than in Kentucky. 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.
New York· 50th of 51
$105
AK $437KY $100
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.