How much rates vary
Facilitymedian $2,570 · 10th to 90th $355 to $5,248Professionalmedian $170 · 10th to 90th $110 to $363
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 $199.53 Median $4,168.69 Typical High $8,128.31 | Facility | None | $199.53 | $4,168.69 | $8,128.31 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $173.78 Typical High $234.42 | Professional | None | $109.65 | $173.78 | $234.42 |
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 $134.90 Median $162.18 Typical High $398.11 | Professional | None | $134.90 | $162.18 | $398.11 |
CDPHP Setting Facility Modifier None Typical Low $1,584.89 Median $2,089.30 Typical High $6,165.95 | Facility | None | $1,584.89 | $2,089.30 | $6,165.95 |
CDPHP Setting Professional Modifier None Typical Low $181.97 Median $181.97 Typical High $309.03 | Professional | None | $181.97 | $181.97 | $309.03 |
Cigna Setting Facility Modifier None Typical Low $302.00 Median $588.84 Typical High $1,737.80 | Facility | None | $302.00 | $588.84 | $1,737.80 |
Cigna Setting Professional Modifier None Typical Low $107.15 Median $181.97 Typical High $389.05 | Professional | None | $107.15 | $181.97 | $389.05 |
Emblem Health Setting Facility Modifier None Typical Low $147.91 Median $208.93 Typical High $501.19 | Facility | None | $147.91 | $208.93 | $501.19 |
Emblem Health Setting Professional Modifier None Typical Low $288.40 Median $323.59 Typical High $524.81 | Professional | None | $288.40 | $323.59 | $524.81 |
Excellus BCBS Setting Professional Modifier None Typical Low $147.91 Median $213.80 Typical High $257.04 | Professional | None | $147.91 | $213.80 | $257.04 |
MVP Health Care Setting Facility Modifier None Typical Low $223.87 Median $3,235.94 Typical High $4,365.16 | Facility | None | $223.87 | $3,235.94 | $4,365.16 |
MVP Health Care Setting Professional Modifier None Typical Low $275.42 Median $275.42 Typical High $398.11 | Professional | None | $275.42 | $275.42 | $398.11 |
United Setting Facility Modifier None Typical Low $363.08 Median $1,174.90 Typical High $4,365.16 | Facility | None | $363.08 | $1,174.90 | $4,365.16 |
United Setting Professional Modifier None Typical Low $89.13 Median $169.82 Typical High $338.84 | Professional | None | $89.13 | $169.82 | $338.84 |
Univera Setting Facility Modifier None Typical Low $93.33 Median $204.17 Typical High $1,047.13 | Facility | None | $93.33 | $204.17 | $1,047.13 |
Univera Setting Professional Modifier None Typical Low $147.91 Median $213.80 Typical High $257.04 | Professional | None | $147.91 | $213.80 | $257.04 |
14 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 $54.95 Median $87.10 Typical High $102.33 | Professional | 52 · Reduced service | $54.95 | $87.10 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $35.48 Typical High $40.74 | Professional | 53 · Discontinued | $21.88 | $35.48 | $40.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $131.83 Typical High $151.36 | Professional | 54 · Surgery only | $83.18 | $131.83 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $26.30 Typical High $30.20 | Professional | 55 · Aftercare only | $16.60 | $26.30 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $17.38 Typical High $20.42 | Professional | 56 · Pre-op care only | $10.96 | $17.38 | $20.42 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $245.47 Typical High $295.12 | Professional | 54 · Surgery only | $158.49 | $245.47 | $295.12 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $30.90 Typical High $37.15 | Professional | 55 · Aftercare only | $19.95 | $30.90 | $37.15 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $30.90 Typical High $37.15 | Professional | 56 · Pre-op care only | $19.95 | $30.90 | $37.15 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $158.49 Median $245.47 Typical High $295.12 | Professional | 78 · Unplanned return to OR | $158.49 | $245.47 | $295.12 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $109.65 Median $138.04 Typical High $165.96 | Professional | 53 · Discontinued | $109.65 | $138.04 | $165.96 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $218.78 Typical High $295.12 | Professional | 54 · Surgery only | $158.49 | $218.78 | $295.12 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $30.90 Typical High $67.61 | Professional | 55 · Aftercare only | $19.95 | $30.90 | $67.61 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $30.90 Typical High $67.61 | Professional | 56 · Pre-op care only | $19.95 | $30.90 | $67.61 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $158.49 Median $218.78 Typical High $295.12 | Professional | 78 · Unplanned return to OR | $158.49 | $218.78 | $295.12 |
Where New York sits
The same service costs 7.2 times more in New York than in Michigan. 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
NY $2,740MI $382
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.