How much rates vary
Facilitymedian $5,129 · 10th to 90th $1,175 to $12,303Professionalmedian $1,202 · 10th to 90th $977 to $2,692
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 $2,187.76 Median $6,309.57 Typical High $13,182.57 | Facility | None | $2,187.76 | $6,309.57 | $13,182.57 |
Aetna Setting Professional Modifier None Typical Low $1,548.82 Median $1,621.81 Typical High $3,630.78 | Professional | None | $1,548.82 | $1,621.81 | $3,630.78 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,819.70 Median $6,918.31 Typical High $13,489.63 | Facility | None | $1,819.70 | $6,918.31 | $13,489.63 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,000.00 Median $1,174.90 Typical High $2,398.83 | Professional | None | $1,000.00 | $1,174.90 | $2,398.83 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $1,513.56 Median $1,778.28 Typical High $3,630.78 | Professional | 50 · Both sides | $1,513.56 | $1,778.28 | $3,630.78 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $630.96 Median $741.31 Typical High $1,479.11 | Professional | 62 · Two surgeons | $630.96 | $741.31 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $158.49 Median $186.21 Typical High $380.19 | Professional | 80 · Assistant surgeon | $158.49 | $186.21 | $380.19 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $141.25 Median $165.96 Typical High $338.84 | Professional | AS · PA/NP assist | $141.25 | $165.96 | $338.84 |
CDPHP Setting Professional Modifier None Typical Low $1,905.46 Median $1,905.46 Typical High $1,905.46 | Professional | None | $1,905.46 | $1,905.46 | $1,905.46 |
Cigna Setting Facility Modifier None Typical Low $851.14 Median $1,778.28 Typical High $3,981.07 | Facility | None | $851.14 | $1,778.28 | $3,981.07 |
Cigna Setting Professional Modifier None Typical Low $1,148.15 Median $1,445.44 Typical High $5,495.41 | Professional | None | $1,148.15 | $1,445.44 | $5,495.41 |
Emblem Health Setting Facility Modifier None Typical Low $1,380.38 Median $2,238.72 Typical High $4,570.88 | Facility | None | $1,380.38 | $2,238.72 | $4,570.88 |
Emblem Health Setting Professional Modifier None Typical Low $1,348.96 Median $1,479.11 Typical High $2,398.83 | Professional | None | $1,348.96 | $1,479.11 | $2,398.83 |
Excellus BCBS Setting Professional Modifier None Typical Low $933.25 Median $1,148.15 Typical High $1,995.26 | Professional | None | $933.25 | $1,148.15 | $1,995.26 |
MVP Health Care Setting Facility Modifier None Typical Low $1,479.11 Median $6,456.54 Typical High $7,079.46 | Facility | None | $1,479.11 | $6,456.54 | $7,079.46 |
MVP Health Care Setting Professional Modifier None Typical Low $1,737.80 Median $1,737.80 Typical High $3,311.31 | Professional | None | $1,737.80 | $1,737.80 | $3,311.31 |
United Setting Facility Modifier None Typical Low $575.44 Median $1,778.28 Typical High $6,606.93 | Facility | None | $575.44 | $1,778.28 | $6,606.93 |
United Setting Professional Modifier None Typical Low $977.24 Median $1,412.54 Typical High $3,715.35 | Professional | None | $977.24 | $1,412.54 | $3,715.35 |
Univera Setting Facility Modifier None Typical Low $1,096.48 Median $1,202.26 Typical High $4,786.30 | Facility | None | $1,096.48 | $1,202.26 | $4,786.30 |
Univera Setting Professional Modifier None Typical Low $933.25 Median $1,148.15 Typical High $1,949.84 | Professional | None | $933.25 | $1,148.15 | $1,949.84 |
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 $776.25 Median $812.83 Typical High $812.83 | Professional | 52 · Reduced service | $776.25 | $812.83 | $812.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $309.03 Median $331.13 Typical High $331.13 | Professional | 53 · Discontinued | $309.03 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,148.15 Median $1,230.27 Typical High $1,230.27 | Professional | 54 · Surgery only | $1,148.15 | $1,230.27 | $1,230.27 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $229.09 Median $245.47 Typical High $245.47 | Professional | 55 · Aftercare only | $229.09 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $154.88 Median $162.18 Typical High $162.18 | Professional | 56 · Pre-op care only | $154.88 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,071.52 Median $1,148.15 Typical High $1,148.15 | Professional | 78 · Unplanned return to OR | $1,071.52 | $1,148.15 | $1,148.15 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $1,047.13 Typical High $1,905.46 | Professional | 54 · Surgery only | $851.14 | $1,047.13 | $1,905.46 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $85.11 Median $102.33 Typical High $190.55 | Professional | 55 · Aftercare only | $85.11 | $102.33 | $190.55 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $91.20 Typical High $169.82 | Professional | 56 · Pre-op care only | $75.86 | $91.20 | $169.82 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $954.99 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $776.25 | $954.99 | $1,737.80 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $691.83 Median $912.01 Typical High $1,348.96 | Professional | 53 · Discontinued | $691.83 | $912.01 | $1,348.96 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $851.14 Median $1,047.13 Typical High $1,905.46 | Professional | 54 · Surgery only | $851.14 | $1,047.13 | $1,905.46 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $85.11 Median $102.33 Typical High $234.42 | Professional | 55 · Aftercare only | $85.11 | $102.33 | $234.42 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $75.86 Median $91.20 Typical High $208.93 | Professional | 56 · Pre-op care only | $75.86 | $91.20 | $208.93 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $954.99 Typical High $1,737.80 | Professional | 78 · Unplanned return to OR | $776.25 | $954.99 | $1,737.80 |
Where New York sits
The same service costs 13.9 times more in Maine than in Maryland. 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 $28,165MD $2,021
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.