How much rates vary
Facilitymedian $2,754 · 10th to 90th $490 to $5,248Professionalmedian $115 · 10th to 90th $89 to $263
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 $3,981.07 Typical High $8,128.31 | Facility | None | $1,122.02 | $3,981.07 | $8,128.31 |
Aetna Setting Professional Modifier None Typical Low $91.20 Median $154.88 Typical High $239.88 | Professional | None | $91.20 | $154.88 | $239.88 |
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 $95.50 Median $112.20 Typical High $239.88 | Professional | None | $95.50 | $112.20 | $239.88 |
CDPHP Setting Facility Modifier None Typical Low $1,148.15 Median $1,348.96 Typical High $4,073.80 | Facility | None | $1,148.15 | $1,348.96 | $4,073.80 |
CDPHP Setting Professional Modifier None Typical Low $112.20 Median $112.20 Typical High $190.55 | Professional | None | $112.20 | $112.20 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $416.87 Median $707.95 Typical High $1,479.11 | Facility | None | $416.87 | $707.95 | $1,479.11 |
Cigna Setting Professional Modifier None Typical Low $69.18 Median $141.25 Typical High $489.78 | Professional | None | $69.18 | $141.25 | $489.78 |
Emblem Health Setting Facility Modifier None Typical Low $34.67 Median $85.11 Typical High $281.84 | Facility | None | $34.67 | $85.11 | $281.84 |
Emblem Health Setting Professional Modifier None Typical Low $162.18 Median $177.83 Typical High $288.40 | Professional | None | $162.18 | $177.83 | $288.40 |
Excellus BCBS Setting Professional Modifier None Typical Low $95.50 Median $134.90 Typical High $213.80 | Professional | None | $95.50 | $134.90 | $213.80 |
Highmark BCBS Setting Facility Modifier None Typical Low $50.12 Median $50.12 Typical High $2,570.40 | Facility | None | $50.12 | $50.12 | $2,570.40 |
MVP Health Care Setting Facility Modifier None Typical Low $102.33 Median $102.33 Typical High $102.33 | Facility | None | $102.33 | $102.33 | $102.33 |
MVP Health Care Setting Professional Modifier None Typical Low $114.82 Median $114.82 Typical High $346.74 | Professional | None | $114.82 | $114.82 | $346.74 |
United Setting Facility Modifier None Typical Low $549.54 Median $1,737.80 Typical High $4,897.79 | Facility | None | $549.54 | $1,737.80 | $4,897.79 |
United Setting Professional Modifier None Typical Low $64.57 Median $125.89 Typical High $323.59 | Professional | None | $64.57 | $125.89 | $323.59 |
Univera Setting Facility Modifier None Typical Low $66.07 Median $123.03 Typical High $288.40 | Facility | None | $66.07 | $123.03 | $288.40 |
Univera Setting Professional Modifier None Typical Low $95.50 Median $134.90 Typical High $199.53 | Professional | None | $95.50 | $134.90 | $199.53 |
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 $45.71 Median $72.44 Typical High $79.43 | Professional | 52 · Reduced service | $45.71 | $72.44 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $18.20 Median $28.84 Typical High $31.62 | Professional | 53 · Discontinued | $18.20 | $28.84 | $31.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $67.61 Median $107.15 Typical High $117.49 | Professional | 54 · Surgery only | $67.61 | $107.15 | $117.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.49 Median $21.38 Typical High $23.44 | Professional | 55 · Aftercare only | $13.49 | $21.38 | $23.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.12 Median $14.45 Typical High $15.85 | Professional | 56 · Pre-op care only | $9.12 | $14.45 | $15.85 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $165.96 Typical High $213.80 | Professional | 54 · Surgery only | $87.10 | $165.96 | $213.80 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $10.96 Median $20.89 Typical High $26.30 | Professional | 55 · Aftercare only | $10.96 | $20.89 | $26.30 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $20.89 Typical High $26.30 | Professional | 56 · Pre-op care only | $10.96 | $20.89 | $26.30 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $87.10 Median $165.96 Typical High $213.80 | Professional | 78 · Unplanned return to OR | $87.10 | $165.96 | $213.80 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $66.07 Median $89.13 Typical High $138.04 | Professional | 53 · Discontinued | $66.07 | $89.13 | $138.04 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $141.25 Typical High $213.80 | Professional | 54 · Surgery only | $87.10 | $141.25 | $213.80 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $10.96 Median $20.89 Typical High $123.03 | Professional | 55 · Aftercare only | $10.96 | $20.89 | $123.03 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $20.89 Typical High $123.03 | Professional | 56 · Pre-op care only | $10.96 | $20.89 | $123.03 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $87.10 Median $141.25 Typical High $213.80 | Professional | 78 · Unplanned return to OR | $87.10 | $141.25 | $213.80 |
Where New York sits
The same service costs 3.6 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· 50th of 51
$120
WI $417KY $115
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.