How much rates vary
Facilitymedian $2,570 · 10th to 90th $117 to $5,012Professionalmedian $91 · 10th to 90th $55 to $178
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 $67.61 Median $3,090.30 Typical High $7,762.47 | Facility | None | $67.61 | $3,090.30 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $60.26 Median $95.50 Typical High $177.83 | Professional | None | $60.26 | $95.50 | $177.83 |
Ambetter Setting Professional Modifier None Typical Low $95.50 Median $107.15 Typical High $194.98 | Professional | None | $95.50 | $107.15 | $194.98 |
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 $75.86 Median $91.20 Typical High $181.97 | Professional | None | $75.86 | $91.20 | $181.97 |
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 $91.20 Median $91.20 Typical High $158.49 | Professional | None | $91.20 | $91.20 | $158.49 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $107.15 Typical High $1,096.48 | Facility | None | $100.00 | $107.15 | $1,096.48 |
Cigna Setting Professional Modifier None Typical Low $40.74 Median $85.11 Typical High $186.21 | Professional | None | $40.74 | $85.11 | $186.21 |
Emblem Health Setting Facility Modifier None Typical Low $44.67 Median $72.44 Typical High $245.47 | Facility | None | $44.67 | $72.44 | $245.47 |
Emblem Health Setting Professional Modifier None Typical Low $8.13 Median $70.79 Typical High $120.23 | Professional | None | $8.13 | $70.79 | $120.23 |
Excellus BCBS Setting Professional Modifier None Typical Low $67.61 Median $91.20 Typical High $131.83 | Professional | None | $67.61 | $91.20 | $131.83 |
Highmark BCBS Setting Facility Modifier None Typical Low $69.18 Median $426.58 Typical High $691.83 | Facility | None | $69.18 | $426.58 | $691.83 |
Highmark BCBS Setting Professional Modifier None Typical Low $100.00 Median $120.23 Typical High $190.55 | Professional | None | $100.00 | $120.23 | $190.55 |
MVP Health Care Setting Facility Modifier None Typical Low $61.66 Median $61.66 Typical High $61.66 | Facility | None | $61.66 | $61.66 | $61.66 |
MVP Health Care Setting Professional Modifier None Typical Low $37.15 Median $37.15 Typical High $208.93 | Professional | None | $37.15 | $37.15 | $208.93 |
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 $43.65 Median $81.28 Typical High $162.18 | Professional | None | $43.65 | $81.28 | $162.18 |
Univera Setting Facility Modifier None Typical Low $51.29 Median $102.33 Typical High $173.78 | Facility | None | $51.29 | $102.33 | $173.78 |
Univera Setting Professional Modifier None Typical Low $67.61 Median $91.20 Typical High $131.83 | Professional | None | $67.61 | $91.20 | $131.83 |
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 $30.20 Median $47.86 Typical High $51.29 | Professional | 52 · Reduced service | $30.20 | $47.86 | $51.29 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $19.05 Typical High $20.42 | Professional | 53 · Discontinued | $12.02 | $19.05 | $20.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $44.67 Median $70.79 Typical High $77.62 | Professional | 54 · Surgery only | $44.67 | $70.79 | $77.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.91 Median $14.13 Typical High $15.49 | Professional | 55 · Aftercare only | $8.91 | $14.13 | $15.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.03 Median $9.55 Typical High $10.23 | Professional | 56 · Pre-op care only | $6.03 | $9.55 | $10.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $41.69 Median $66.07 Typical High $72.44 | Professional | 78 · Unplanned return to OR | $41.69 | $66.07 | $72.44 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $95.50 Typical High $117.49 | Professional | 54 · Surgery only | $67.61 | $95.50 | $117.49 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $10.72 Typical High $13.18 | Professional | 55 · Aftercare only | $7.59 | $10.72 | $13.18 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $10.72 Typical High $13.18 | Professional | 56 · Pre-op care only | $7.59 | $10.72 | $13.18 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $60.26 Median $85.11 Typical High $104.71 | Professional | 78 · Unplanned return to OR | $60.26 | $85.11 | $104.71 |
Fidelis Setting Professional Modifier SU · In-office procedure Typical Low $346.74 Median $346.74 Typical High $346.74 | Professional | SU · In-office procedure | $346.74 | $346.74 | $346.74 |
Highmark BCBS Setting Professional Modifier 59 · Distinct service Typical Low $91.20 Median $117.49 Typical High $169.82 | Professional | 59 · Distinct service | $91.20 | $117.49 | $169.82 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $57.54 Median $72.44 Typical High $83.18 | Professional | 53 · Discontinued | $57.54 | $72.44 | $83.18 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $95.50 Typical High $117.49 | Professional | 54 · Surgery only | $67.61 | $95.50 | $117.49 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $10.72 Typical High $14.45 | Professional | 55 · Aftercare only | $7.59 | $10.72 | $14.45 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $10.72 Typical High $14.45 | Professional | 56 · Pre-op care only | $7.59 | $10.72 | $14.45 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $60.26 Median $85.11 Typical High $104.71 | Professional | 78 · Unplanned return to OR | $60.26 | $85.11 | $104.71 |
Where New York sits
The same service costs 3.9 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· 47th of 51
$91.20
AK $309KY $79.43
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.