How much rates vary
Facilitymedian $3,802 · 10th to 90th $676 to $9,550Professionalmedian $562 · 10th to 90th $380 to $1,096
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 $562.34 Median $3,801.89 Typical High $8,317.64 | Facility | None | $562.34 | $3,801.89 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $489.78 Median $676.08 Typical High $1,122.02 | Professional | None | $489.78 | $676.08 | $1,122.02 |
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 $457.09 Median $562.34 Typical High $1,000.00 | Professional | None | $457.09 | $562.34 | $1,000.00 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $691.83 Median $831.76 Typical High $1,479.11 | Professional | 50 · Both sides | $691.83 | $831.76 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $288.40 Median $346.74 Typical High $630.96 | Professional | 62 · Two surgeons | $288.40 | $346.74 | $630.96 |
CDPHP Setting Facility Modifier None Typical Low $2,951.21 Median $2,951.21 Typical High $8,912.51 | Facility | None | $2,951.21 | $2,951.21 | $8,912.51 |
CDPHP Setting Professional Modifier None Typical Low $467.74 Median $467.74 Typical High $724.44 | Professional | None | $467.74 | $467.74 | $724.44 |
Cigna Setting Facility Modifier None Typical Low $346.74 Median $645.65 Typical High $1,862.09 | Facility | None | $346.74 | $645.65 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $275.42 Median $426.58 Typical High $1,412.54 | Professional | None | $275.42 | $426.58 | $1,412.54 |
Emblem Health Setting Facility Modifier None Typical Low $363.08 Median $676.08 Typical High $1,412.54 | Facility | None | $363.08 | $676.08 | $1,412.54 |
Emblem Health Setting Professional Modifier None Typical Low $537.03 Median $616.60 Typical High $1,096.48 | Professional | None | $537.03 | $616.60 | $1,096.48 |
Excellus BCBS Setting Professional Modifier None Typical Low $323.59 Median $467.74 Typical High $676.08 | Professional | None | $323.59 | $467.74 | $676.08 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,548.82 Median $3,090.30 Typical High $7,413.10 | Facility | None | $1,548.82 | $3,090.30 | $7,413.10 |
Highmark BCBS Setting Professional Modifier None Typical Low $426.58 Median $831.76 Typical High $1,202.26 | Professional | None | $426.58 | $831.76 | $1,202.26 |
MVP Health Care Setting Facility Modifier None Typical Low $588.84 Median $4,786.30 Typical High $5,754.40 | Facility | None | $588.84 | $4,786.30 | $5,754.40 |
MVP Health Care Setting Professional Modifier None Typical Low $758.58 Median $758.58 Typical High $1,318.26 | Professional | None | $758.58 | $758.58 | $1,318.26 |
United Setting Facility Modifier None Typical Low $1,230.27 Median $3,162.28 Typical High $9,332.54 | Facility | None | $1,230.27 | $3,162.28 | $9,332.54 |
United Setting Professional Modifier None Typical Low $295.12 Median $537.03 Typical High $1,230.27 | Professional | None | $295.12 | $537.03 | $1,230.27 |
Univera Setting Facility Modifier None Typical Low $234.42 Median $467.74 Typical High $1,862.09 | Facility | None | $234.42 | $467.74 | $1,862.09 |
Univera Setting Professional Modifier None Typical Low $323.59 Median $467.74 Typical High $676.08 | Professional | None | $323.59 | $467.74 | $676.08 |
14 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 $257.04 Median $338.84 Typical High $354.81 | Professional | 52 · Reduced service | $257.04 | $338.84 | $354.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $102.33 Median $134.90 Typical High $141.25 | Professional | 53 · Discontinued | $102.33 | $134.90 | $141.25 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $380.19 Median $512.86 Typical High $524.81 | Professional | 54 · Surgery only | $380.19 | $512.86 | $524.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $75.86 Median $102.33 Typical High $107.15 | Professional | 55 · Aftercare only | $75.86 | $102.33 | $107.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $51.29 Median $67.61 Typical High $70.79 | Professional | 56 · Pre-op care only | $51.29 | $67.61 | $70.79 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $354.81 Median $478.63 Typical High $489.78 | Professional | 78 · Unplanned return to OR | $354.81 | $478.63 | $489.78 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $288.40 Median $416.87 Typical High $630.96 | Professional | 54 · Surgery only | $288.40 | $416.87 | $630.96 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $46.77 Typical High $69.18 | Professional | 55 · Aftercare only | $32.36 | $46.77 | $69.18 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $32.36 Median $46.77 Typical High $69.18 | Professional | 56 · Pre-op care only | $32.36 | $46.77 | $69.18 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $257.04 Median $371.54 Typical High $562.34 | Professional | 78 · Unplanned return to OR | $257.04 | $371.54 | $562.34 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $288.40 Median $416.87 Typical High $602.56 | Professional | 54 · Surgery only | $288.40 | $416.87 | $602.56 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $46.77 Typical High $89.13 | Professional | 55 · Aftercare only | $32.36 | $46.77 | $89.13 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $32.36 Median $46.77 Typical High $89.13 | Professional | 56 · Pre-op care only | $32.36 | $46.77 | $89.13 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $257.04 Median $371.54 Typical High $562.34 | Professional | 78 · Unplanned return to OR | $257.04 | $371.54 | $562.34 |
Where New York sits
The same service costs 4.3 times more in Wisconsin than in Texas. 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· 43rd of 51
$589
WI $1,862TX $437
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.