How much rates vary
Facilitymedian $3,162 · 10th to 90th $501 to $7,413Professionalmedian $219 · 10th to 90th $145 to $427
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 $1,122.02 Median $4,168.69 Typical High $8,128.31 | Facility | None | $1,122.02 | $4,168.69 | $8,128.31 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $229.09 Typical High $398.11 | Professional | None | $131.83 | $229.09 | $398.11 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,288.25 Median $3,890.45 Typical High $7,943.28 | Facility | None | $1,288.25 | $3,890.45 | $7,943.28 |
Anthem BCBS Setting Professional Modifier None Typical Low $194.98 Median $229.09 Typical High $398.11 | Professional | None | $194.98 | $229.09 | $398.11 |
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 $173.78 Median $173.78 Typical High $309.03 | Professional | None | $173.78 | $173.78 | $309.03 |
Cigna Setting Facility Modifier None Typical Low $223.87 Median $426.58 Typical High $1,778.28 | Facility | None | $223.87 | $426.58 | $1,778.28 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $169.82 Typical High $724.44 | Professional | None | $93.33 | $169.82 | $724.44 |
Emblem Health Setting Facility Modifier None Typical Low $100.00 Median $141.25 Typical High $446.68 | Facility | None | $100.00 | $141.25 | $446.68 |
Emblem Health Setting Professional Modifier None Typical Low $234.42 Median $269.15 Typical High $446.68 | Professional | None | $234.42 | $269.15 | $446.68 |
Excellus BCBS Setting Professional Modifier None Typical Low $144.54 Median $204.17 Typical High $288.40 | Professional | None | $144.54 | $204.17 | $288.40 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,238.72 Median $2,238.72 Typical High $2,238.72 | Facility | None | $2,238.72 | $2,238.72 | $2,238.72 |
MVP Health Care Setting Facility Modifier None Typical Low $128.82 Median $128.82 Typical High $128.82 | Facility | None | $128.82 | $128.82 | $128.82 |
MVP Health Care Setting Professional Modifier None Typical Low $147.91 Median $147.91 Typical High $457.09 | Professional | None | $147.91 | $147.91 | $457.09 |
United Setting Facility Modifier None Typical Low $812.83 Median $2,238.72 Typical High $6,760.83 | Facility | None | $812.83 | $2,238.72 | $6,760.83 |
United Setting Professional Modifier None Typical Low $95.50 Median $186.21 Typical High $501.19 | Professional | None | $95.50 | $186.21 | $501.19 |
Univera Setting Facility Modifier None Typical Low $79.43 Median $199.53 Typical High $426.58 | Facility | None | $79.43 | $199.53 | $426.58 |
Univera Setting Professional Modifier None Typical Low $144.54 Median $199.53 Typical High $288.40 | Professional | None | $144.54 | $199.53 | $288.40 |
16 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 $75.86 Median $114.82 Typical High $120.23 | Professional | 52 · Reduced service | $75.86 | $114.82 | $120.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.20 Median $45.71 Typical High $48.98 | Professional | 53 · Discontinued | $30.20 | $45.71 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $169.82 Typical High $181.97 | Professional | 54 · Surgery only | $112.20 | $169.82 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $34.67 Typical High $36.31 | Professional | 55 · Aftercare only | $22.39 | $34.67 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $22.91 Typical High $24.55 | Professional | 56 · Pre-op care only | $15.14 | $22.91 | $24.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $104.71 Median $158.49 Typical High $169.82 | Professional | 78 · Unplanned return to OR | $104.71 | $158.49 | $169.82 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $186.21 Typical High $281.84 | Professional | 54 · Surgery only | $128.82 | $186.21 | $281.84 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $14.45 Median $20.42 Typical High $31.62 | Professional | 55 · Aftercare only | $14.45 | $20.42 | $31.62 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $20.42 Typical High $31.62 | Professional | 56 · Pre-op care only | $14.45 | $20.42 | $31.62 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $165.96 Typical High $251.19 | Professional | 78 · Unplanned return to OR | $114.82 | $165.96 | $251.19 |
Highmark BCBS Setting Professional Modifier 59 · Distinct service Typical Low $251.19 Median $251.19 Typical High $251.19 | Professional | 59 · Distinct service | $251.19 | $251.19 | $251.19 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $107.15 Median $141.25 Typical High $218.78 | Professional | 53 · Discontinued | $107.15 | $141.25 | $218.78 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $186.21 Typical High $257.04 | Professional | 54 · Surgery only | $128.82 | $186.21 | $257.04 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $14.45 Median $20.42 Typical High $41.69 | Professional | 55 · Aftercare only | $14.45 | $20.42 | $41.69 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $20.42 Typical High $41.69 | Professional | 56 · Pre-op care only | $14.45 | $20.42 | $41.69 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $114.82 Median $165.96 Typical High $229.09 | Professional | 78 · Unplanned return to OR | $114.82 | $165.96 | $229.09 |
Where New York sits
The same service costs 3.8 times more in Wisconsin 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· 28th of 51
$229
WI $631KY $166
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.