How much rates vary
Facilitymedian $4,467 · 10th to 90th $1,047 to $10,715Professionalmedian $1,230 · 10th to 90th $977 to $2,512
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 $1,819.70 Median $6,165.95 Typical High $10,964.78 | Facility | None | $1,819.70 | $6,165.95 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $1,445.44 Median $1,584.89 Typical High $2,238.72 | Professional | None | $1,445.44 | $1,584.89 | $2,238.72 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,698.24 Median $6,456.54 Typical High $12,589.25 | Facility | None | $1,698.24 | $6,456.54 | $12,589.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,047.13 Median $1,230.27 Typical High $2,290.87 | Professional | None | $1,047.13 | $1,230.27 | $2,290.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $660.69 Median $776.25 Typical High $1,445.44 | Professional | 62 · Two surgeons | $660.69 | $776.25 | $1,445.44 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $165.96 Median $194.98 Typical High $363.08 | Professional | 80 · Assistant surgeon | $165.96 | $194.98 | $363.08 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $147.91 Median $173.78 Typical High $316.23 | Professional | AS · PA/NP assist | $147.91 | $173.78 | $316.23 |
CDPHP Setting Professional Modifier None Typical Low $1,819.70 Median $1,819.70 Typical High $1,819.70 | Professional | None | $1,819.70 | $1,819.70 | $1,819.70 |
Cigna Setting Facility Modifier None Typical Low $851.14 Median $1,778.28 Typical High $2,754.23 | Facility | None | $851.14 | $1,778.28 | $2,754.23 |
Cigna Setting Professional Modifier None Typical Low $1,096.48 Median $1,380.38 Typical High $5,011.87 | Professional | None | $1,096.48 | $1,380.38 | $5,011.87 |
Emblem Health Setting Facility Modifier None Typical Low $1,318.26 Median $2,089.30 Typical High $4,466.84 | Facility | None | $1,318.26 | $2,089.30 | $4,466.84 |
Emblem Health Setting Professional Modifier None Typical Low $1,288.25 Median $1,412.54 Typical High $2,290.87 | Professional | None | $1,288.25 | $1,412.54 | $2,290.87 |
Excellus BCBS Setting Professional Modifier None Typical Low $891.25 Median $1,096.48 Typical High $1,905.46 | Professional | None | $891.25 | $1,096.48 | $1,905.46 |
MVP Health Care Setting Facility Modifier None Typical Low $1,380.38 Median $1,380.38 Typical High $4,786.30 | Facility | None | $1,380.38 | $1,380.38 | $4,786.30 |
MVP Health Care Setting Professional Modifier None Typical Low $1,288.25 Median $1,288.25 Typical High $3,162.28 | Professional | None | $1,288.25 | $1,288.25 | $3,162.28 |
United Setting Facility Modifier None Typical Low $512.86 Median $1,698.24 Typical High $4,897.79 | Facility | None | $512.86 | $1,698.24 | $4,897.79 |
United Setting Professional Modifier None Typical Low $933.25 Median $1,348.96 Typical High $3,548.13 | Professional | None | $933.25 | $1,348.96 | $3,548.13 |
Univera Setting Facility Modifier None Typical Low $1,047.13 Median $1,122.02 Typical High $4,168.69 | Facility | None | $1,047.13 | $1,122.02 | $4,168.69 |
Univera Setting Professional Modifier None Typical Low $891.25 Median $1,096.48 Typical High $1,862.09 | Professional | None | $891.25 | $1,096.48 | $1,862.09 |
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 $724.44 Median $776.25 Typical High $776.25 | Professional | 52 · Reduced service | $724.44 | $776.25 | $776.25 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $295.12 Median $316.23 Typical High $316.23 | Professional | 53 · Discontinued | $295.12 | $316.23 | $316.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,096.48 Median $1,174.90 Typical High $1,174.90 | Professional | 54 · Surgery only | $1,096.48 | $1,174.90 | $1,174.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $218.78 Median $234.42 Typical High $234.42 | Professional | 55 · Aftercare only | $218.78 | $234.42 | $234.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $144.54 Median $158.49 Typical High $158.49 | Professional | 56 · Pre-op care only | $144.54 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,023.29 Median $1,096.48 Typical High $1,096.48 | Professional | 78 · Unplanned return to OR | $1,023.29 | $1,096.48 | $1,096.48 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $1,000.00 Typical High $1,819.70 | Professional | 54 · Surgery only | $812.83 | $1,000.00 | $1,819.70 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $81.28 Median $100.00 Typical High $181.97 | Professional | 55 · Aftercare only | $81.28 | $100.00 | $181.97 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $87.10 Typical High $162.18 | Professional | 56 · Pre-op care only | $72.44 | $87.10 | $162.18 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $912.01 Typical High $1,659.59 | Professional | 78 · Unplanned return to OR | $741.31 | $912.01 | $1,659.59 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $660.69 Median $851.14 Typical High $1,288.25 | Professional | 53 · Discontinued | $660.69 | $851.14 | $1,288.25 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $1,000.00 Typical High $1,819.70 | Professional | 54 · Surgery only | $812.83 | $1,000.00 | $1,819.70 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $81.28 Median $100.00 Typical High $223.87 | Professional | 55 · Aftercare only | $81.28 | $100.00 | $223.87 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $87.10 Typical High $199.53 | Professional | 56 · Pre-op care only | $72.44 | $87.10 | $199.53 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $741.31 Median $912.01 Typical High $1,659.59 | Professional | 78 · Unplanned return to OR | $741.31 | $912.01 | $1,659.59 |
Where New York sits
The same service costs 13.1 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 $24,687MD $1,882
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.