How much rates vary
Facilitymedian $2,512 · 10th to 90th $295 to $4,898Professionalmedian $240 · 10th to 90th $151 to $501
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 $309.03 Median $3,801.89 Typical High $9,772.37 | Facility | None | $309.03 | $3,801.89 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $194.98 Median $251.19 Typical High $407.38 | Professional | None | $194.98 | $251.19 | $407.38 |
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 $213.80 Median $251.19 Typical High $467.74 | Professional | None | $213.80 | $251.19 | $467.74 |
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 $234.42 Median $234.42 Typical High $398.11 | Professional | None | $234.42 | $234.42 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $223.87 Typical High $446.68 | Facility | None | $100.00 | $223.87 | $446.68 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $213.80 Typical High $758.58 | Professional | None | $114.82 | $213.80 | $758.58 |
Emblem Health Setting Facility Modifier None Typical Low $151.36 Median $204.17 Typical High $575.44 | Facility | None | $151.36 | $204.17 | $575.44 |
Emblem Health Setting Professional Modifier None Typical Low $251.19 Median $288.40 Typical High $467.74 | Professional | None | $251.19 | $288.40 | $467.74 |
Excellus BCBS Setting Professional Modifier None Typical Low $151.36 Median $218.78 Typical High $338.84 | Professional | None | $151.36 | $218.78 | $338.84 |
Highmark BCBS Setting Facility Modifier None Typical Low $489.78 Median $489.78 Typical High $489.78 | Facility | None | $489.78 | $489.78 | $489.78 |
MVP Health Care Setting Facility Modifier None Typical Low $165.96 Median $3,235.94 Typical High $4,365.16 | Facility | None | $165.96 | $3,235.94 | $4,365.16 |
MVP Health Care Setting Professional Modifier None Typical Low $134.90 Median $134.90 Typical High $575.44 | Professional | None | $134.90 | $134.90 | $575.44 |
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 $125.89 Median $239.88 Typical High $645.65 | Professional | None | $125.89 | $239.88 | $645.65 |
Univera Setting Facility Modifier None Typical Low $95.50 Median $213.80 Typical High $537.03 | Facility | None | $95.50 | $213.80 | $537.03 |
Univera Setting Professional Modifier None Typical Low $151.36 Median $213.80 Typical High $338.84 | Professional | None | $151.36 | $213.80 | $338.84 |
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 $95.50 Median $123.03 Typical High $154.88 | Professional | 52 · Reduced service | $95.50 | $123.03 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $50.12 Typical High $61.66 | Professional | 53 · Discontinued | $38.90 | $50.12 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $186.21 Typical High $234.42 | Professional | 54 · Surgery only | $144.54 | $186.21 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $37.15 Typical High $46.77 | Professional | 55 · Aftercare only | $28.84 | $37.15 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $25.12 Typical High $30.90 | Professional | 56 · Pre-op care only | $19.50 | $25.12 | $30.90 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $134.90 Median $173.78 Typical High $218.78 | Professional | 78 · Unplanned return to OR | $134.90 | $173.78 | $218.78 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $199.53 Typical High $302.00 | Professional | 54 · Surgery only | $134.90 | $199.53 | $302.00 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $21.88 Typical High $33.88 | Professional | 55 · Aftercare only | $15.14 | $21.88 | $33.88 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $21.88 Typical High $33.88 | Professional | 56 · Pre-op care only | $15.14 | $21.88 | $33.88 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $177.83 Typical High $269.15 | Professional | 78 · Unplanned return to OR | $120.23 | $177.83 | $269.15 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $141.25 Median $186.21 Typical High $234.42 | Professional | 53 · Discontinued | $141.25 | $186.21 | $234.42 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $199.53 Typical High $302.00 | Professional | 54 · Surgery only | $134.90 | $199.53 | $302.00 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $21.88 Typical High $43.65 | Professional | 55 · Aftercare only | $15.14 | $21.88 | $43.65 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $21.88 Typical High $43.65 | Professional | 56 · Pre-op care only | $15.14 | $21.88 | $43.65 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $177.83 Typical High $269.15 | Professional | 78 · Unplanned return to OR | $120.23 | $177.83 | $269.15 |
Where New York sits
The same service costs 3.7 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· 30th of 51
$251
WI $708TX $191
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.