How much rates vary
Facilitymedian $4,169 · 10th to 90th $1,349 to $10,715Professionalmedian $4,786 · 10th to 90th $813 to $9,772
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 $812.83 Median $977.24 Typical High $3,630.78 | Facility | None | $812.83 | $977.24 | $3,630.78 |
Aetna Setting Professional Modifier None Typical Low $812.83 Median $977.24 Typical High $977.24 | Professional | None | $812.83 | $977.24 | $977.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $120.23 Median $144.54 Typical High $144.54 | Professional | 55 · Aftercare only | $120.23 | $144.54 | $144.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $97.72 Typical High $97.72 | Professional | 56 · Pre-op care only | $81.28 | $97.72 | $97.72 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $676.08 Typical High $676.08 | Professional | 78 · Unplanned return to OR | $562.34 | $676.08 | $676.08 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,513.56 Median $4,466.84 Typical High $10,964.78 | Facility | None | $1,513.56 | $4,466.84 | $10,964.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,479.11 Median $1,737.80 Typical High $8,317.64 | Professional | None | $1,479.11 | $1,737.80 | $8,317.64 |
CDPHP Setting Professional Modifier None Typical Low $4,786.30 Median $4,786.30 Typical High $4,786.30 | Professional | None | $4,786.30 | $4,786.30 | $4,786.30 |
Cigna Setting Facility Modifier None Typical Low $1,621.81 Median $2,511.89 Typical High $5,128.61 | Facility | None | $1,621.81 | $2,511.89 | $5,128.61 |
Cigna Setting Professional Modifier None Typical Low $3,090.30 Median $3,090.30 Typical High $7,413.10 | Professional | None | $3,090.30 | $3,090.30 | $7,413.10 |
Emblem Health Setting Facility Modifier None Typical Low $1,096.48 Median $1,819.70 Typical High $4,168.69 | Facility | None | $1,096.48 | $1,819.70 | $4,168.69 |
Emblem Health Setting Professional Modifier None Typical Low $363.08 Median $7,413.10 Typical High $11,748.98 | Professional | None | $363.08 | $7,413.10 | $11,748.98 |
Excellus BCBS Setting Professional Modifier None Typical Low $537.03 Median $6,165.95 Typical High $8,709.64 | Professional | None | $537.03 | $6,165.95 | $8,709.64 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $794.33 Median $1,318.26 Typical High $1,949.84 | Professional | 55 · Aftercare only | $794.33 | $1,318.26 | $1,949.84 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $380.19 Median $616.60 Typical High $933.25 | Professional | 56 · Pre-op care only | $380.19 | $616.60 | $933.25 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,570.40 Median $4,265.80 Typical High $6,456.54 | Professional | 78 · Unplanned return to OR | $2,570.40 | $4,265.80 | $6,456.54 |
MVP Health Care Setting Facility Modifier None Typical Low $776.25 Median $776.25 Typical High $776.25 | Facility | None | $776.25 | $776.25 | $776.25 |
MVP Health Care Setting Professional Modifier None Typical Low $398.11 Median $398.11 Typical High $10,471.29 | Professional | None | $398.11 | $398.11 | $10,471.29 |
United Setting Facility Modifier None Typical Low $1,318.26 Median $3,548.13 Typical High $11,220.18 | Facility | None | $1,318.26 | $3,548.13 | $11,220.18 |
United Setting Professional Modifier None Typical Low $3,801.89 Median $6,309.57 Typical High $14,791.08 | Professional | None | $3,801.89 | $6,309.57 | $14,791.08 |
Univera Setting Facility Modifier None Typical Low $363.08 Median $707.95 Typical High $17,782.79 | Facility | None | $363.08 | $707.95 | $17,782.79 |
Univera Setting Professional Modifier None Typical Low $537.03 Median $5,495.41 Typical High $8,709.64 | Professional | None | $537.03 | $5,495.41 | $8,709.64 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $794.33 Median $1,318.26 Typical High $1,819.70 | Professional | 55 · Aftercare only | $794.33 | $1,318.26 | $1,819.70 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $380.19 Median $616.60 Typical High $870.96 | Professional | 56 · Pre-op care only | $380.19 | $616.60 | $870.96 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,570.40 Median $4,265.80 Typical High $6,025.60 | Professional | 78 · Unplanned return to OR | $2,570.40 | $4,265.80 | $6,025.60 |
4 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 $398.11 Median $489.78 Typical High $489.78 | Professional | 52 · Reduced service | $398.11 | $489.78 | $489.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $162.18 Median $194.98 Typical High $194.98 | Professional | 53 · Discontinued | $162.18 | $194.98 | $194.98 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $2,951.21 Median $4,897.79 Typical High $7,413.10 | Professional | 54 · Surgery only | $2,951.21 | $4,897.79 | $7,413.10 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $2,951.21 Median $4,897.79 Typical High $6,918.31 | Professional | 54 · Surgery only | $2,951.21 | $4,897.79 | $6,918.31 |
Where New York sits
The same service costs 21.4 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· 16th of 51
$4,571
AK $13,804KY $646
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.