How much rates vary
Facilitymedian $2,630 · 10th to 90th $295 to $5,012Professionalmedian $34 · 10th to 90th $26 to $76
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 $1,318.26 Median $4,265.80 Typical High $8,128.31 | Facility | None | $1,318.26 | $4,265.80 | $8,128.31 |
Aetna Setting Professional Modifier None Typical Low $36.31 Median $36.31 Typical High $100.00 | Professional | None | $36.31 | $36.31 | $100.00 |
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 $27.54 Median $32.36 Typical High $64.57 | Professional | None | $27.54 | $32.36 | $64.57 |
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 $48.98 Median $48.98 Typical High $48.98 | Professional | None | $48.98 | $48.98 | $48.98 |
Cigna Setting Facility Modifier None Typical Low $173.78 Median $331.13 Typical High $1,479.11 | Facility | None | $173.78 | $331.13 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $26.30 Median $44.67 Typical High $199.53 | Professional | None | $26.30 | $44.67 | $199.53 |
Emblem Health Setting Facility Modifier None Typical Low $35.48 Median $46.77 Typical High $125.89 | Facility | None | $35.48 | $46.77 | $125.89 |
Emblem Health Setting Professional Modifier None Typical Low $35.48 Median $39.81 Typical High $61.66 | Professional | None | $35.48 | $39.81 | $61.66 |
Excellus BCBS Setting Professional Modifier None Typical Low $23.44 Median $29.51 Typical High $43.65 | Professional | None | $23.44 | $29.51 | $43.65 |
Highmark BCBS Setting Facility Modifier None Typical Low $741.31 Median $741.31 Typical High $741.31 | Facility | None | $741.31 | $741.31 | $741.31 |
MVP Health Care Setting Professional Modifier None Typical Low $57.54 Median $67.61 Typical High $87.10 | Professional | None | $57.54 | $67.61 | $87.10 |
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 $24.55 Median $36.31 Typical High $100.00 | Professional | None | $24.55 | $36.31 | $100.00 |
Univera Setting Facility Modifier None Typical Low $25.12 Median $38.90 Typical High $162.18 | Facility | None | $25.12 | $38.90 | $162.18 |
Univera Setting Professional Modifier None Typical Low $21.38 Median $29.51 Typical High $43.65 | Professional | None | $21.38 | $29.51 | $43.65 |
6 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 $18.20 Median $18.20 Typical High $20.89 | Professional | 52 · Reduced service | $18.20 | $18.20 | $20.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $7.41 Typical High $8.32 | Professional | 53 · Discontinued | $7.41 | $7.41 | $8.32 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $27.54 Median $27.54 Typical High $30.90 | Professional | 54 · Surgery only | $27.54 | $27.54 | $30.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $5.50 Typical High $6.31 | Professional | 55 · Aftercare only | $5.50 | $5.50 | $6.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.63 Median $3.63 Typical High $4.17 | Professional | 56 · Pre-op care only | $3.63 | $3.63 | $4.17 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $17.78 Median $23.44 Typical High $35.48 | Professional | 53 · Discontinued | $17.78 | $23.44 | $35.48 |
Where New York sits
The same service costs 24.8 times more in New York than in Montana. 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 $2,664MT $107
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.