How much rates vary
Facilitymedian $3,311 · 10th to 90th $324 to $7,762Professionalmedian $174 · 10th to 90th $123 to $324
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 $398.11 Median $4,265.80 Typical High $8,128.31 | Facility | None | $398.11 | $4,265.80 | $8,128.31 |
Aetna Setting Professional Modifier None Typical Low $114.82 Median $147.91 Typical High $316.23 | Professional | None | $114.82 | $147.91 | $316.23 |
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 $151.36 Median $181.97 Typical High $288.40 | Professional | None | $151.36 | $181.97 | $288.40 |
CDPHP Setting Facility Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $6,165.95 | Facility | None | $2,089.30 | $2,089.30 | $6,165.95 |
CDPHP Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $229.09 | Professional | None | $158.49 | $158.49 | $229.09 |
Cigna Setting Facility Modifier None Typical Low $125.89 Median $234.42 Typical High $1,778.28 | Facility | None | $125.89 | $234.42 | $1,778.28 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $173.78 Typical High $512.86 | Professional | None | $114.82 | $173.78 | $512.86 |
Emblem Health Setting Facility Modifier None Typical Low $34.67 Median $120.23 Typical High $398.11 | Facility | None | $34.67 | $120.23 | $398.11 |
Emblem Health Setting Professional Modifier None Typical Low $177.83 Median $204.17 Typical High $338.84 | Professional | None | $177.83 | $204.17 | $338.84 |
Excellus BCBS Setting Professional Modifier None Typical Low $109.65 Median $154.88 Typical High $234.42 | Professional | None | $109.65 | $154.88 | $234.42 |
Highmark BCBS Setting Facility Modifier None Typical Low $3,162.28 Median $3,162.28 Typical High $3,162.28 | Facility | None | $3,162.28 | $3,162.28 | $3,162.28 |
MVP Health Care Setting Facility Modifier None Typical Low $123.03 Median $3,235.94 Typical High $4,365.16 | Facility | None | $123.03 | $3,235.94 | $4,365.16 |
MVP Health Care Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $380.19 | Professional | None | $151.36 | $151.36 | $380.19 |
United Setting Facility Modifier None Typical Low $1,122.02 Median $2,754.23 Typical High $7,762.47 | Facility | None | $1,122.02 | $2,754.23 | $7,762.47 |
United Setting Professional Modifier None Typical Low $102.33 Median $173.78 Typical High $346.74 | Professional | None | $102.33 | $173.78 | $346.74 |
Univera Setting Facility Modifier None Typical Low $83.18 Median $154.88 Typical High $371.54 | Facility | None | $83.18 | $154.88 | $371.54 |
Univera Setting Professional Modifier None Typical Low $109.65 Median $154.88 Typical High $213.80 | Professional | None | $109.65 | $154.88 | $213.80 |
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 $57.54 Median $74.13 Typical High $81.28 | Professional | 52 · Reduced service | $57.54 | $74.13 | $81.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $22.91 Median $29.51 Typical High $32.36 | Professional | 53 · Discontinued | $22.91 | $29.51 | $32.36 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $112.20 Typical High $120.23 | Professional | 54 · Surgery only | $87.10 | $112.20 | $120.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $22.39 Typical High $24.55 | Professional | 55 · Aftercare only | $17.38 | $22.39 | $24.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.48 Median $14.79 Typical High $16.22 | Professional | 56 · Pre-op care only | $11.48 | $14.79 | $16.22 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $81.28 Median $104.71 Typical High $112.20 | Professional | 78 · Unplanned return to OR | $81.28 | $104.71 | $112.20 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $141.25 Typical High $218.78 | Professional | 54 · Surgery only | $100.00 | $141.25 | $218.78 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $10.96 Median $15.49 Typical High $23.99 | Professional | 55 · Aftercare only | $10.96 | $15.49 | $23.99 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $15.49 Typical High $23.99 | Professional | 56 · Pre-op care only | $10.96 | $15.49 | $23.99 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $89.13 Median $125.89 Typical High $190.55 | Professional | 78 · Unplanned return to OR | $89.13 | $125.89 | $190.55 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $75.86 Median $102.33 Typical High $169.82 | Professional | 53 · Discontinued | $75.86 | $102.33 | $169.82 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $141.25 Typical High $208.93 | Professional | 54 · Surgery only | $100.00 | $141.25 | $208.93 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $10.96 Median $15.49 Typical High $32.36 | Professional | 55 · Aftercare only | $10.96 | $15.49 | $32.36 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $15.49 Typical High $32.36 | Professional | 56 · Pre-op care only | $10.96 | $15.49 | $32.36 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $89.13 Median $125.89 Typical High $186.21 | Professional | 78 · Unplanned return to OR | $89.13 | $125.89 | $186.21 |
Where New York sits
The same service costs 3.6 times more in Wisconsin than in Texas. 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· 30th of 51
$178
WI $468TX $129
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.