How much rates vary
Facilitymedian $2,630 · 10th to 90th $302 to $4,898Professionalmedian $145 · 10th to 90th $100 to $288
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 $186.21 Median $3,801.89 Typical High $9,772.37 | Facility | None | $186.21 | $3,801.89 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $169.82 Typical High $257.04 | Professional | None | $131.83 | $169.82 | $257.04 |
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 $125.89 Median $147.91 Typical High $257.04 | Professional | None | $125.89 | $147.91 | $257.04 |
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 $154.88 Median $154.88 Typical High $199.53 | Professional | None | $154.88 | $154.88 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $154.88 Typical High $1,096.48 | Facility | None | $100.00 | $154.88 | $1,096.48 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $147.91 Typical High $512.86 | Professional | None | $93.33 | $147.91 | $512.86 |
Emblem Health Setting Facility Modifier None Typical Low $100.00 Median $123.03 Typical High $407.38 | Facility | None | $100.00 | $123.03 | $407.38 |
Emblem Health Setting Professional Modifier None Typical Low $165.96 Median $181.97 Typical High $295.12 | Professional | None | $165.96 | $181.97 | $295.12 |
Excellus BCBS Setting Professional Modifier None Typical Low $97.72 Median $131.83 Typical High $208.93 | Professional | None | $97.72 | $131.83 | $208.93 |
Highmark BCBS Setting Facility Modifier None Typical Low $50.12 Median $50.12 Typical High $50.12 | Facility | None | $50.12 | $50.12 | $50.12 |
MVP Health Care Setting Facility Modifier None Typical Low $107.15 Median $107.15 Typical High $107.15 | Facility | None | $107.15 | $107.15 | $107.15 |
MVP Health Care Setting Professional Modifier None Typical Low $97.72 Median $97.72 Typical High $346.74 | Professional | None | $97.72 | $97.72 | $346.74 |
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 $81.28 Median $131.83 Typical High $354.81 | Professional | None | $81.28 | $131.83 | $354.81 |
Univera Setting Facility Modifier None Typical Low $66.07 Median $128.82 Typical High $331.13 | Facility | None | $66.07 | $128.82 | $331.13 |
Univera Setting Professional Modifier None Typical Low $97.72 Median $128.82 Typical High $208.93 | Professional | None | $97.72 | $128.82 | $208.93 |
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 $66.07 Median $74.13 Typical High $93.33 | Professional | 52 · Reduced service | $66.07 | $74.13 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.30 Median $29.51 Typical High $37.15 | Professional | 53 · Discontinued | $26.30 | $29.51 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $112.20 Typical High $138.04 | Professional | 54 · Surgery only | $100.00 | $112.20 | $138.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $22.39 Typical High $27.54 | Professional | 55 · Aftercare only | $19.95 | $22.39 | $27.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $14.79 Typical High $18.62 | Professional | 56 · Pre-op care only | $13.18 | $14.79 | $18.62 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $93.33 Median $104.71 Typical High $128.82 | Professional | 78 · Unplanned return to OR | $93.33 | $104.71 | $128.82 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $123.03 Typical High $213.80 | Professional | 54 · Surgery only | $89.13 | $123.03 | $213.80 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $13.80 Typical High $23.44 | Professional | 55 · Aftercare only | $9.77 | $13.80 | $23.44 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $9.77 Median $13.80 Typical High $23.44 | Professional | 56 · Pre-op care only | $9.77 | $13.80 | $23.44 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $109.65 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $79.43 | $109.65 | $186.21 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $70.79 Median $93.33 Typical High $147.91 | Professional | 53 · Discontinued | $70.79 | $93.33 | $147.91 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $123.03 Typical High $190.55 | Professional | 54 · Surgery only | $89.13 | $123.03 | $190.55 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $13.80 Typical High $28.84 | Professional | 55 · Aftercare only | $9.77 | $13.80 | $28.84 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $9.77 Median $13.80 Typical High $28.84 | Professional | 56 · Pre-op care only | $9.77 | $13.80 | $28.84 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $79.43 Median $109.65 Typical High $169.82 | Professional | 78 · Unplanned return to OR | $79.43 | $109.65 | $169.82 |
Where New York sits
The same service costs 4.1 times more in Alaska 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· 37th of 51
$148
AK $457KY $112
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.