How much rates vary
Facilitymedian $5,248 · 10th to 90th $1,202 to $13,804Professionalmedian $1,778 · 10th to 90th $1,413 to $3,631
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 $2,344.23 Median $6,606.93 Typical High $13,803.84 | Facility | None | $2,344.23 | $6,606.93 | $13,803.84 |
Aetna Setting Professional Modifier None Typical Low $2,041.74 Median $2,041.74 Typical High $5,754.40 | Professional | None | $2,041.74 | $2,041.74 | $5,754.40 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,737.80 Median $7,413.10 Typical High $14,791.08 | Facility | None | $1,737.80 | $7,413.10 | $14,791.08 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,479.11 Median $1,778.28 Typical High $3,311.31 | Professional | None | $1,479.11 | $1,778.28 | $3,311.31 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $2,238.72 Median $2,691.53 Typical High $5,011.87 | Professional | 50 · Both sides | $2,238.72 | $2,691.53 | $5,011.87 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $239.88 Median $288.40 Typical High $537.03 | Professional | 80 · Assistant surgeon | $239.88 | $288.40 | $537.03 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $208.93 Median $251.19 Typical High $467.74 | Professional | AS · PA/NP assist | $208.93 | $251.19 | $467.74 |
CDPHP Setting Facility Modifier None Typical Low $18,620.87 Median $18,620.87 Typical High $18,620.87 | Facility | None | $18,620.87 | $18,620.87 | $18,620.87 |
CDPHP Setting Professional Modifier None Typical Low $2,570.40 Median $2,570.40 Typical High $2,570.40 | Professional | None | $2,570.40 | $2,570.40 | $2,570.40 |
Cigna Setting Facility Modifier None Typical Low $851.14 Median $1,778.28 Typical High $2,951.21 | Facility | None | $851.14 | $1,778.28 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $1,862.09 Median $1,905.46 Typical High $6,165.95 | Professional | None | $1,862.09 | $1,905.46 | $6,165.95 |
Emblem Health Setting Facility Modifier None Typical Low $1,778.28 Median $2,454.71 Typical High $6,456.54 | Facility | None | $1,778.28 | $2,454.71 | $6,456.54 |
Emblem Health Setting Professional Modifier None Typical Low $1,819.70 Median $2,137.96 Typical High $3,715.35 | Professional | None | $1,819.70 | $2,137.96 | $3,715.35 |
Excellus BCBS Setting Professional Modifier None Typical Low $1,174.90 Median $1,548.82 Typical High $2,454.71 | Professional | None | $1,174.90 | $1,548.82 | $2,454.71 |
MVP Health Care Setting Facility Modifier None Typical Low $2,238.72 Median $4,786.30 Typical High $5,754.40 | Facility | None | $2,238.72 | $4,786.30 | $5,754.40 |
MVP Health Care Setting Professional Modifier None Typical Low $1,659.59 Median $1,659.59 Typical High $4,677.35 | Professional | None | $1,659.59 | $1,659.59 | $4,677.35 |
United Setting Facility Modifier None Typical Low $575.44 Median $1,778.28 Typical High $6,165.95 | Facility | None | $575.44 | $1,778.28 | $6,165.95 |
United Setting Professional Modifier None Typical Low $1,412.54 Median $2,089.30 Typical High $5,495.41 | Professional | None | $1,412.54 | $2,089.30 | $5,495.41 |
Univera Setting Facility Modifier None Typical Low $1,258.93 Median $1,698.24 Typical High $3,019.95 | Facility | None | $1,258.93 | $1,698.24 | $3,019.95 |
Univera Setting Professional Modifier None Typical Low $1,174.90 Median $1,548.82 Typical High $2,454.71 | Professional | None | $1,174.90 | $1,548.82 | $2,454.71 |
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 $1,023.29 Median $1,023.29 Typical High $1,230.27 | Professional | 52 · Reduced service | $1,023.29 | $1,023.29 | $1,230.27 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $407.38 Median $407.38 Typical High $489.78 | Professional | 53 · Discontinued | $407.38 | $407.38 | $489.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,513.56 Median $1,513.56 Typical High $1,819.70 | Professional | 54 · Surgery only | $1,513.56 | $1,513.56 | $1,819.70 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $302.00 Median $302.00 Typical High $363.08 | Professional | 55 · Aftercare only | $302.00 | $302.00 | $363.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $204.17 Median $204.17 Typical High $245.47 | Professional | 56 · Pre-op care only | $204.17 | $204.17 | $245.47 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,445.44 Typical High $2,344.23 | Professional | 54 · Surgery only | $1,096.48 | $1,445.44 | $2,344.23 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $83.18 Median $109.65 Typical High $177.83 | Professional | 55 · Aftercare only | $83.18 | $109.65 | $177.83 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $107.15 Median $138.04 Typical High $229.09 | Professional | 56 · Pre-op care only | $107.15 | $138.04 | $229.09 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,288.25 Typical High $2,137.96 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,288.25 | $2,137.96 |
Univera Setting Facility Modifier 54 · Surgery only Typical Low $1,174.90 Median $1,584.89 Typical High $2,137.96 | Facility | 54 · Surgery only | $1,174.90 | $1,584.89 | $2,137.96 |
Univera Setting Facility Modifier 55 · Aftercare only Typical Low $87.10 Median $131.83 Typical High $158.49 | Facility | 55 · Aftercare only | $87.10 | $131.83 | $158.49 |
Univera Setting Facility Modifier 56 · Pre-op care only Typical Low $112.20 Median $169.82 Typical High $204.17 | Facility | 56 · Pre-op care only | $112.20 | $169.82 | $204.17 |
Univera Setting Facility Modifier 78 · Unplanned return to OR Typical Low $1,047.13 Median $1,584.89 Typical High $1,905.46 | Facility | 78 · Unplanned return to OR | $1,047.13 | $1,584.89 | $1,905.46 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,445.44 Typical High $2,344.23 | Professional | 54 · Surgery only | $1,096.48 | $1,445.44 | $2,344.23 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $83.18 Median $112.20 Typical High $239.88 | Professional | 55 · Aftercare only | $83.18 | $112.20 | $239.88 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $107.15 Median $144.54 Typical High $309.03 | Professional | 56 · Pre-op care only | $107.15 | $144.54 | $309.03 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,000.00 Median $1,348.96 Typical High $2,137.96 | Professional | 78 · Unplanned return to OR | $1,000.00 | $1,348.96 | $2,137.96 |
Where New York sits
The same service costs 11.7 times more in Maine than in Washington. 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
ME $28,334WA $2,413
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.