How much rates vary
Facilitymedian $3,467 · 10th to 90th $832 to $7,762Professionalmedian $204 · 10th to 90th $158 to $457
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 $812.83 Median $4,786.30 Typical High $8,317.64 | Facility | None | $812.83 | $4,786.30 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $213.80 Median $245.47 Typical High $457.09 | Professional | None | $213.80 | $245.47 | $457.09 |
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 $165.96 Median $194.98 Typical High $380.19 | Professional | None | $165.96 | $194.98 | $380.19 |
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 $257.04 Median $257.04 Typical High $295.12 | Professional | None | $257.04 | $257.04 | $295.12 |
Cigna Setting Facility Modifier None Typical Low $1,148.15 Median $2,884.03 Typical High $5,623.41 | Facility | None | $1,148.15 | $2,884.03 | $5,623.41 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $223.87 Typical High $776.25 | Professional | None | $158.49 | $223.87 | $776.25 |
Emblem Health Setting Facility Modifier None Typical Low $190.55 Median $346.74 Typical High $724.44 | Facility | None | $190.55 | $346.74 | $724.44 |
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 $151.36 Median $208.93 Typical High $338.84 | Professional | None | $151.36 | $208.93 | $338.84 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,801.89 Median $3,801.89 Typical High $3,801.89 | Facility | None | $3,801.89 | $3,801.89 | $3,801.89 |
MVP Health Care Setting Facility Modifier None Typical Low $204.17 Median $3,235.94 Typical High $4,365.16 | Facility | None | $204.17 | $3,235.94 | $4,365.16 |
MVP Health Care Setting Professional Modifier None Typical Low $208.93 Median $208.93 Typical High $512.86 | Professional | None | $208.93 | $208.93 | $512.86 |
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 $147.91 Median $208.93 Typical High $575.44 | Professional | None | $147.91 | $208.93 | $575.44 |
Univera Setting Facility Modifier None Typical Low $154.88 Median $190.55 Typical High $645.65 | Facility | None | $154.88 | $190.55 | $645.65 |
Univera Setting Professional Modifier None Typical Low $151.36 Median $190.55 Typical High $338.84 | Professional | None | $151.36 | $190.55 | $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 $107.15 Median $114.82 Typical High $125.89 | Professional | 52 · Reduced service | $107.15 | $114.82 | $125.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $42.66 Median $45.71 Typical High $51.29 | Professional | 53 · Discontinued | $42.66 | $45.71 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $158.49 Median $169.82 Typical High $190.55 | Professional | 54 · Surgery only | $158.49 | $169.82 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $33.88 Typical High $38.02 | Professional | 55 · Aftercare only | $31.62 | $33.88 | $38.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.38 Median $22.91 Typical High $25.12 | Professional | 56 · Pre-op care only | $21.38 | $22.91 | $25.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $147.91 Median $158.49 Typical High $177.83 | Professional | 78 · Unplanned return to OR | $147.91 | $158.49 | $177.83 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $190.55 Typical High $316.23 | Professional | 54 · Surgery only | $134.90 | $190.55 | $316.23 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $20.89 Typical High $34.67 | Professional | 55 · Aftercare only | $15.14 | $20.89 | $34.67 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $20.89 Typical High $34.67 | Professional | 56 · Pre-op care only | $15.14 | $20.89 | $34.67 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $169.82 Typical High $281.84 | Professional | 78 · Unplanned return to OR | $120.23 | $169.82 | $281.84 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $107.15 Median $138.04 Typical High $213.80 | Professional | 53 · Discontinued | $107.15 | $138.04 | $213.80 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $134.90 Median $190.55 Typical High $302.00 | Professional | 54 · Surgery only | $134.90 | $190.55 | $302.00 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $20.89 Typical High $41.69 | Professional | 55 · Aftercare only | $15.14 | $20.89 | $41.69 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $20.89 Typical High $41.69 | Professional | 56 · Pre-op care only | $15.14 | $20.89 | $41.69 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $120.23 Median $169.82 Typical High $269.15 | Professional | 78 · Unplanned return to OR | $120.23 | $169.82 | $269.15 |
Where New York sits
The same service costs 5.9 times more in Oklahoma than in Utah. 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
$209
OK $1,175UT $200
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.