How much rates vary
Facilitymedian $5,623 · 10th to 90th $1,202 to $14,454Professionalmedian $2,630 · 10th to 90th $2,042 to $6,026
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 $1,905.46 Median $6,309.57 Typical High $12,302.69 | Facility | None | $1,905.46 | $6,309.57 | $12,302.69 |
Aetna Setting Professional Modifier None Typical Low $3,090.30 Median $3,090.30 Typical High $7,413.10 | Professional | None | $3,090.30 | $3,090.30 | $7,413.10 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,862.09 Median $8,709.64 Typical High $15,488.17 | Facility | None | $1,862.09 | $8,709.64 | $15,488.17 |
Anthem BCBS Setting Professional Modifier None Typical Low $2,089.30 Median $2,454.71 Typical High $5,370.32 | Professional | None | $2,089.30 | $2,454.71 | $5,370.32 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $3,162.28 Median $3,715.35 Typical High $8,128.31 | Professional | 50 · Both sides | $3,162.28 | $3,715.35 | $8,128.31 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,318.26 Median $1,548.82 Typical High $3,388.44 | Professional | 62 · Two surgeons | $1,318.26 | $1,548.82 | $3,388.44 |
CDPHP Setting Professional Modifier None Typical Low $4,073.80 Median $4,073.80 Typical High $4,073.80 | Professional | None | $4,073.80 | $4,073.80 | $4,073.80 |
Cigna Setting Facility Modifier None Typical Low $851.14 Median $1,778.28 Typical High $4,168.69 | Facility | None | $851.14 | $1,778.28 | $4,168.69 |
Cigna Setting Professional Modifier None Typical Low $2,511.89 Median $2,951.21 Typical High $13,489.63 | Professional | None | $2,511.89 | $2,951.21 | $13,489.63 |
Emblem Health Setting Facility Modifier None Typical Low $2,570.40 Median $4,677.35 Typical High $9,549.93 | Facility | None | $2,570.40 | $4,677.35 | $9,549.93 |
Emblem Health Setting Professional Modifier None Typical Low $2,691.53 Median $2,951.21 Typical High $4,786.30 | Professional | None | $2,691.53 | $2,951.21 | $4,786.30 |
Excellus BCBS Setting Professional Modifier None Typical Low $1,905.46 Median $2,238.72 Typical High $3,467.37 | Professional | None | $1,905.46 | $2,238.72 | $3,467.37 |
MVP Health Care Setting Facility Modifier None Typical Low $2,754.23 Median $5,754.40 Typical High $87,096.36 | Facility | None | $2,754.23 | $5,754.40 | $87,096.36 |
MVP Health Care Setting Professional Modifier None Typical Low $3,090.30 Median $3,090.30 Typical High $6,918.31 | Professional | None | $3,090.30 | $3,090.30 | $6,918.31 |
United Setting Facility Modifier None Typical Low $575.44 Median $1,737.80 Typical High $6,165.95 | Facility | None | $575.44 | $1,737.80 | $6,165.95 |
United Setting Professional Modifier None Typical Low $1,949.84 Median $3,311.31 Typical High $8,128.31 | Professional | None | $1,949.84 | $3,311.31 | $8,128.31 |
Univera Setting Facility Modifier None Typical Low $2,398.83 Median $2,630.27 Typical High $9,772.37 | Facility | None | $2,398.83 | $2,630.27 | $9,772.37 |
Univera Setting Professional Modifier None Typical Low $1,905.46 Median $2,238.72 Typical High $3,467.37 | Professional | None | $1,905.46 | $2,238.72 | $3,467.37 |
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 $1,548.82 Median $1,548.82 Typical High $1,621.81 | Professional | 52 · Reduced service | $1,548.82 | $1,548.82 | $1,621.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $630.96 Median $630.96 Typical High $660.69 | Professional | 53 · Discontinued | $630.96 | $630.96 | $660.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,344.23 Median $2,344.23 Typical High $2,454.71 | Professional | 54 · Surgery only | $2,344.23 | $2,344.23 | $2,454.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $467.74 Median $467.74 Typical High $489.78 | Professional | 55 · Aftercare only | $467.74 | $467.74 | $489.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $309.03 Median $309.03 Typical High $323.59 | Professional | 56 · Pre-op care only | $309.03 | $309.03 | $323.59 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,187.76 Median $2,187.76 Typical High $2,290.87 | Professional | 78 · Unplanned return to OR | $2,187.76 | $2,187.76 | $2,290.87 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $1,659.59 Median $1,949.84 Typical High $3,235.94 | Professional | 54 · Surgery only | $1,659.59 | $1,949.84 | $3,235.94 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $295.12 Typical High $478.63 | Professional | 55 · Aftercare only | $251.19 | $295.12 | $478.63 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $208.93 Median $251.19 Typical High $407.38 | Professional | 56 · Pre-op care only | $208.93 | $251.19 | $407.38 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $1,698.24 Typical High $2,818.38 | Professional | 78 · Unplanned return to OR | $1,445.44 | $1,698.24 | $2,818.38 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $1,348.96 Median $1,778.28 Typical High $2,754.23 | Professional | 53 · Discontinued | $1,348.96 | $1,778.28 | $2,754.23 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $1,659.59 Median $1,995.26 Typical High $3,019.95 | Professional | 54 · Surgery only | $1,659.59 | $1,995.26 | $3,019.95 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $295.12 Typical High $691.83 | Professional | 55 · Aftercare only | $251.19 | $295.12 | $691.83 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $208.93 Median $251.19 Typical High $575.44 | Professional | 56 · Pre-op care only | $208.93 | $251.19 | $575.44 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,445.44 Median $1,737.80 Typical High $2,630.27 | Professional | 78 · Unplanned return to OR | $1,445.44 | $1,737.80 | $2,630.27 |
Where New York sits
The same service costs 12.3 times more in Maine than in Washington. 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 $36,075WA $2,929
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.