How much rates vary
Facilitymedian $2,630 · 10th to 90th $155 to $5,012Professionalmedian $56 · 10th to 90th $40 to $110
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 $60.26 Median $3,548.13 Typical High $7,762.47 | Facility | None | $60.26 | $3,548.13 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $45.71 Median $57.54 Typical High $117.49 | Professional | None | $45.71 | $57.54 | $117.49 |
Ambetter Setting Professional Modifier None Typical Low $63.10 Median $67.61 Typical High $128.82 | Professional | None | $63.10 | $67.61 | $128.82 |
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 $45.71 Median $53.70 Typical High $120.23 | Professional | None | $45.71 | $53.70 | $120.23 |
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 $75.86 Median $75.86 Typical High $93.33 | Professional | None | $75.86 | $75.86 | $93.33 |
Cigna Setting Facility Modifier None Typical Low $95.50 Median $100.00 Typical High $1,096.48 | Facility | None | $95.50 | $100.00 | $1,096.48 |
Cigna Setting Professional Modifier None Typical Low $33.88 Median $66.07 Typical High $109.65 | Professional | None | $33.88 | $66.07 | $109.65 |
Emblem Health Setting Facility Modifier None Typical Low $30.90 Median $56.23 Typical High $186.21 | Facility | None | $30.90 | $56.23 | $186.21 |
Emblem Health Setting Professional Modifier None Typical Low $18.20 Median $60.26 Typical High $70.79 | Professional | None | $18.20 | $60.26 | $70.79 |
Excellus BCBS Setting Professional Modifier None Typical Low $45.71 Median $60.26 Typical High $83.18 | Professional | None | $45.71 | $60.26 | $83.18 |
Highmark BCBS Setting Facility Modifier None Typical Low $36.31 Median $181.97 Typical High $691.83 | Facility | None | $36.31 | $181.97 | $691.83 |
Highmark BCBS Setting Professional Modifier None Typical Low $63.10 Median $72.44 Typical High $107.15 | Professional | None | $63.10 | $72.44 | $107.15 |
MVP Health Care Setting Facility Modifier None Typical Low $52.48 Median $52.48 Typical High $52.48 | Facility | None | $52.48 | $52.48 | $52.48 |
MVP Health Care Setting Professional Modifier None Typical Low $48.98 Median $48.98 Typical High $141.25 | Professional | None | $48.98 | $48.98 | $141.25 |
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 $33.11 Median $56.23 Typical High $107.15 | Professional | None | $33.11 | $56.23 | $107.15 |
Univera Setting Facility Modifier None Typical Low $40.74 Median $60.26 Typical High $169.82 | Facility | None | $40.74 | $60.26 | $169.82 |
Univera Setting Professional Modifier None Typical Low $45.71 Median $60.26 Typical High $83.18 | Professional | None | $45.71 | $60.26 | $83.18 |
17 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 $22.91 Median $28.84 Typical High $30.90 | Professional | 52 · Reduced service | $22.91 | $28.84 | $30.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.12 Median $11.48 Typical High $12.30 | Professional | 53 · Discontinued | $9.12 | $11.48 | $12.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $34.67 Median $42.66 Typical High $45.71 | Professional | 54 · Surgery only | $34.67 | $42.66 | $45.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.92 Median $8.51 Typical High $9.12 | Professional | 55 · Aftercare only | $6.92 | $8.51 | $9.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.57 Median $5.75 Typical High $6.17 | Professional | 56 · Pre-op care only | $4.57 | $5.75 | $6.17 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $32.36 Median $39.81 Typical High $42.66 | Professional | 78 · Unplanned return to OR | $32.36 | $39.81 | $42.66 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $41.69 Median $57.54 Typical High $74.13 | Professional | 54 · Surgery only | $41.69 | $57.54 | $74.13 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $4.57 Median $6.31 Typical High $8.32 | Professional | 55 · Aftercare only | $4.57 | $6.31 | $8.32 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $4.57 Median $6.31 Typical High $8.32 | Professional | 56 · Pre-op care only | $4.57 | $6.31 | $8.32 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $37.15 Median $51.29 Typical High $66.07 | Professional | 78 · Unplanned return to OR | $37.15 | $51.29 | $66.07 |
Fidelis Setting Professional Modifier 59 · Distinct service Typical Low $30.20 Median $30.20 Typical High $30.20 | Professional | 59 · Distinct service | $30.20 | $30.20 | $30.20 |
Highmark BCBS Setting Professional Modifier 59 · Distinct service Typical Low $61.66 Median $64.57 Typical High $100.00 | Professional | 59 · Distinct service | $61.66 | $64.57 | $100.00 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $41.69 Typical High $51.29 | Professional | 53 · Discontinued | $33.88 | $41.69 | $51.29 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $41.69 Median $57.54 Typical High $74.13 | Professional | 54 · Surgery only | $41.69 | $57.54 | $74.13 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $4.57 Median $6.31 Typical High $8.91 | Professional | 55 · Aftercare only | $4.57 | $6.31 | $8.91 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $4.57 Median $6.31 Typical High $8.91 | Professional | 56 · Pre-op care only | $4.57 | $6.31 | $8.91 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $37.15 Median $51.29 Typical High $66.07 | Professional | 78 · Unplanned return to OR | $37.15 | $51.29 | $66.07 |
Where New York sits
The same service costs 4.2 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· 49th of 51
$57.54
AK $224KY $53.70
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.