How much rates vary
Facilitymedian $5,754 · 10th to 90th $1,202 to $14,454Professionalmedian $2,818 · 10th to 90th $2,291 to $6,310
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 $3,162.28 Median $3,630.78 Typical High $6,606.93 | Professional | None | $3,162.28 | $3,630.78 | $6,606.93 |
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 $2,344.23 Median $2,754.23 Typical High $5,623.41 | Professional | None | $2,344.23 | $2,754.23 | $5,623.41 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,479.11 Median $1,737.80 Typical High $3,467.37 | Professional | 62 · Two surgeons | $1,479.11 | $1,737.80 | $3,467.37 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $371.54 Median $436.52 Typical High $891.25 | Professional | 80 · Assistant surgeon | $371.54 | $436.52 | $891.25 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $331.13 Median $389.05 Typical High $776.25 | Professional | AS · PA/NP assist | $331.13 | $389.05 | $776.25 |
CDPHP Setting Professional Modifier None Typical Low $3,890.45 Median $3,890.45 Typical High $3,890.45 | Professional | None | $3,890.45 | $3,890.45 | $3,890.45 |
Cigna Setting Facility Modifier None Typical Low $851.14 Median $1,778.28 Typical High $4,786.30 | Facility | None | $851.14 | $1,778.28 | $4,786.30 |
Cigna Setting Professional Modifier None Typical Low $2,691.53 Median $3,162.28 Typical High $15,488.17 | Professional | None | $2,691.53 | $3,162.28 | $15,488.17 |
Emblem Health Setting Facility Modifier None Typical Low $3,090.30 Median $6,025.60 Typical High $11,481.54 | Facility | None | $3,090.30 | $6,025.60 | $11,481.54 |
Emblem Health Setting Professional Modifier None Typical Low $3,311.31 Median $3,630.78 Typical High $6,025.60 | Professional | None | $3,311.31 | $3,630.78 | $6,025.60 |
Excellus BCBS Setting Professional Modifier None Typical Low $2,137.96 Median $2,511.89 Typical High $3,630.78 | Professional | None | $2,137.96 | $2,511.89 | $3,630.78 |
MVP Health Care Setting Facility Modifier None Typical Low $2,884.03 Median $4,786.30 Typical High $5,754.40 | Facility | None | $2,884.03 | $4,786.30 | $5,754.40 |
MVP Health Care Setting Professional Modifier None Typical Low $3,715.35 Median $3,715.35 Typical High $7,585.78 | Professional | None | $3,715.35 | $3,715.35 | $7,585.78 |
United Setting Facility Modifier None Typical Low $575.44 Median $1,778.28 Typical High $6,309.57 | Facility | None | $575.44 | $1,778.28 | $6,309.57 |
United Setting Professional Modifier None Typical Low $2,398.83 Median $3,801.89 Typical High $9,120.11 | Professional | None | $2,398.83 | $3,801.89 | $9,120.11 |
Univera Setting Facility Modifier None Typical Low $2,511.89 Median $2,754.23 Typical High $11,220.18 | Facility | None | $2,511.89 | $2,754.23 | $11,220.18 |
Univera Setting Professional Modifier None Typical Low $2,137.96 Median $2,511.89 Typical High $3,548.13 | Professional | None | $2,137.96 | $2,511.89 | $3,548.13 |
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 $1,584.89 Median $1,819.70 Typical High $1,819.70 | Professional | 52 · Reduced service | $1,584.89 | $1,819.70 | $1,819.70 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $630.96 Median $724.44 Typical High $724.44 | Professional | 53 · Discontinued | $630.96 | $724.44 | $724.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,398.83 Median $2,754.23 Typical High $2,754.23 | Professional | 54 · Surgery only | $2,398.83 | $2,754.23 | $2,754.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $478.63 Median $549.54 Typical High $549.54 | Professional | 55 · Aftercare only | $478.63 | $549.54 | $549.54 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $316.23 Median $363.08 Typical High $363.08 | Professional | 56 · Pre-op care only | $316.23 | $363.08 | $363.08 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $2,238.72 Median $2,570.40 Typical High $2,570.40 | Professional | 78 · Unplanned return to OR | $2,238.72 | $2,570.40 | $2,570.40 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $1,862.09 Median $2,187.76 Typical High $3,311.31 | Professional | 54 · Surgery only | $1,862.09 | $2,187.76 | $3,311.31 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $275.42 Median $331.13 Typical High $489.78 | Professional | 55 · Aftercare only | $275.42 | $331.13 | $489.78 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $234.42 Median $275.42 Typical High $416.87 | Professional | 56 · Pre-op care only | $234.42 | $275.42 | $416.87 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,621.81 Median $1,905.46 Typical High $2,884.03 | Professional | 78 · Unplanned return to OR | $1,621.81 | $1,905.46 | $2,884.03 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $1,412.54 Median $1,949.84 Typical High $2,818.38 | Professional | 53 · Discontinued | $1,412.54 | $1,949.84 | $2,818.38 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $1,862.09 Median $2,187.76 Typical High $3,090.30 | Professional | 54 · Surgery only | $1,862.09 | $2,187.76 | $3,090.30 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $275.42 Median $331.13 Typical High $707.95 | Professional | 55 · Aftercare only | $275.42 | $331.13 | $707.95 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $234.42 Median $275.42 Typical High $602.56 | Professional | 56 · Pre-op care only | $234.42 | $275.42 | $602.56 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,621.81 Median $1,905.46 Typical High $2,754.23 | Professional | 78 · Unplanned return to OR | $1,621.81 | $1,905.46 | $2,754.23 |
Where New York sits
The same service costs 13.1 times more in Maine 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.
Physician feeFacility fee
ME $36,340TX $2,769
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.