How much rates vary
Facilitymedian $3,890 · 10th to 90th $776 to $9,550Professionalmedian $479 · 10th to 90th $355 to $1,148
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 $478.63 Median $3,715.35 Typical High $8,128.31 | Facility | None | $478.63 | $3,715.35 | $8,128.31 |
Aetna Setting Professional Modifier None Typical Low $436.52 Median $537.03 Typical High $1,096.48 | Professional | None | $436.52 | $537.03 | $1,096.48 |
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 $380.19 Median $446.68 Typical High $1,047.13 | Professional | None | $380.19 | $446.68 | $1,047.13 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $575.44 Median $676.08 Typical High $1,548.82 | Professional | 50 · Both sides | $575.44 | $676.08 | $1,548.82 |
CDPHP Setting Facility Modifier None Typical Low $1,584.89 Median $2,089.30 Typical High $6,165.95 | Facility | None | $1,584.89 | $2,089.30 | $6,165.95 |
CDPHP Setting Professional Modifier None Typical Low $588.84 Median $588.84 Typical High $741.31 | Professional | None | $588.84 | $588.84 | $741.31 |
Cigna Setting Facility Modifier None Typical Low $1,148.15 Median $2,691.53 Typical High $5,248.07 | Facility | None | $1,148.15 | $2,691.53 | $5,248.07 |
Cigna Setting Professional Modifier None Typical Low $338.84 Median $467.74 Typical High $1,905.46 | Professional | None | $338.84 | $467.74 | $1,905.46 |
Emblem Health Setting Facility Modifier None Typical Low $371.54 Median $501.19 Typical High $1,548.82 | Facility | None | $371.54 | $501.19 | $1,548.82 |
Emblem Health Setting Professional Modifier None Typical Low $602.56 Median $691.83 Typical High $1,148.15 | Professional | None | $602.56 | $691.83 | $1,148.15 |
Excellus BCBS Setting Professional Modifier None Typical Low $354.81 Median $524.81 Typical High $616.60 | Professional | None | $354.81 | $524.81 | $616.60 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,089.30 Median $4,466.84 Typical High $13,489.63 | Facility | None | $2,089.30 | $4,466.84 | $13,489.63 |
Highmark BCBS Setting Professional Modifier None Typical Low $489.78 Median $489.78 Typical High $851.14 | Professional | None | $489.78 | $489.78 | $851.14 |
MVP Health Care Setting Facility Modifier None Typical Low $426.58 Median $3,235.94 Typical High $4,365.16 | Facility | None | $426.58 | $3,235.94 | $4,365.16 |
MVP Health Care Setting Professional Modifier None Typical Low $338.84 Median $338.84 Typical High $1,318.26 | Professional | None | $338.84 | $338.84 | $1,318.26 |
United Setting Facility Modifier None Typical Low $1,122.02 Median $2,754.23 Typical High $7,943.28 | Facility | None | $1,122.02 | $2,754.23 | $7,943.28 |
United Setting Professional Modifier None Typical Low $346.74 Median $575.44 Typical High $1,318.26 | Professional | None | $346.74 | $575.44 | $1,318.26 |
Univera Setting Facility Modifier None Typical Low $218.78 Median $489.78 Typical High $1,258.93 | Facility | None | $218.78 | $489.78 | $1,258.93 |
Univera Setting Professional Modifier None Typical Low $354.81 Median $489.78 Typical High $616.60 | Professional | None | $354.81 | $489.78 | $616.60 |
15 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 $218.78 Median $269.15 Typical High $288.40 | Professional | 52 · Reduced service | $218.78 | $269.15 | $288.40 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $87.10 Median $107.15 Typical High $117.49 | Professional | 53 · Discontinued | $87.10 | $107.15 | $117.49 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $331.13 Median $407.38 Typical High $436.52 | Professional | 54 · Surgery only | $331.13 | $407.38 | $436.52 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $81.28 Typical High $87.10 | Professional | 55 · Aftercare only | $66.07 | $81.28 | $87.10 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $53.70 Typical High $58.88 | Professional | 56 · Pre-op care only | $43.65 | $53.70 | $58.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $309.03 Median $380.19 Typical High $407.38 | Professional | 78 · Unplanned return to OR | $309.03 | $380.19 | $407.38 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $316.23 Median $467.74 Typical High $616.60 | Professional | 54 · Surgery only | $316.23 | $467.74 | $616.60 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $52.48 Typical High $69.18 | Professional | 55 · Aftercare only | $35.48 | $52.48 | $69.18 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $35.48 Median $52.48 Typical High $69.18 | Professional | 56 · Pre-op care only | $35.48 | $52.48 | $69.18 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $416.87 Typical High $549.54 | Professional | 78 · Unplanned return to OR | $281.84 | $416.87 | $549.54 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $263.03 Median $354.81 Typical High $537.03 | Professional | 53 · Discontinued | $263.03 | $354.81 | $537.03 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $316.23 Median $467.74 Typical High $549.54 | Professional | 54 · Surgery only | $316.23 | $467.74 | $549.54 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $52.48 Typical High $102.33 | Professional | 55 · Aftercare only | $35.48 | $52.48 | $102.33 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $35.48 Median $52.48 Typical High $102.33 | Professional | 56 · Pre-op care only | $35.48 | $52.48 | $102.33 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $416.87 Typical High $489.78 | Professional | 78 · Unplanned return to OR | $281.84 | $416.87 | $489.78 |
Where New York sits
The same service costs 5.4 times more in Wisconsin than in West Virginia. 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
WI $6,411WV $1,178
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.