How much rates vary
Facilitymedian $5,623 · 10th to 90th $1,202 to $14,454Professionalmedian $2,570 · 10th to 90th $2,089 to $5,754
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 $2,884.03 Median $3,311.31 Typical High $6,025.60 | Professional | None | $2,884.03 | $3,311.31 | $6,025.60 |
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 $2,137.96 Median $2,511.89 Typical High $5,128.61 | Professional | None | $2,137.96 | $2,511.89 | $5,128.61 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,348.96 Median $1,584.89 Typical High $3,162.28 | Professional | 62 · Two surgeons | $1,348.96 | $1,584.89 | $3,162.28 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $346.74 Median $407.38 Typical High $812.83 | Professional | 80 · Assistant surgeon | $346.74 | $407.38 | $812.83 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $302.00 Median $354.81 Typical High $724.44 | Professional | AS · PA/NP assist | $302.00 | $354.81 | $724.44 |
CDPHP Setting Professional Modifier None Typical Low $3,548.13 Median $3,548.13 Typical High $3,548.13 | Professional | None | $3,548.13 | $3,548.13 | $3,548.13 |
Cigna Setting Facility Modifier None Typical Low $851.14 Median $1,778.28 Typical High $4,365.16 | Facility | None | $851.14 | $1,778.28 | $4,365.16 |
Cigna Setting Professional Modifier None Typical Low $2,454.71 Median $3,090.30 Typical High $14,125.38 | Professional | None | $2,454.71 | $3,090.30 | $14,125.38 |
Emblem Health Setting Facility Modifier None Typical Low $2,884.03 Median $4,365.16 Typical High $10,000.00 | Facility | None | $2,884.03 | $4,365.16 | $10,000.00 |
Emblem Health Setting Professional Modifier None Typical Low $3,019.95 Median $3,311.31 Typical High $5,495.41 | Professional | None | $3,019.95 | $3,311.31 | $5,495.41 |
Excellus BCBS Setting Professional Modifier None Typical Low $1,949.84 Median $2,290.87 Typical High $3,311.31 | Professional | None | $1,949.84 | $2,290.87 | $3,311.31 |
MVP Health Care Setting Facility Modifier None Typical Low $2,630.27 Median $4,786.30 Typical High $5,754.40 | Facility | None | $2,630.27 | $4,786.30 | $5,754.40 |
MVP Health Care Setting Professional Modifier None Typical Low $3,548.13 Median $3,548.13 Typical High $6,918.31 | Professional | None | $3,548.13 | $3,548.13 | $6,918.31 |
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 $2,187.76 Median $3,467.37 Typical High $8,317.64 | Professional | None | $2,187.76 | $3,467.37 | $8,317.64 |
Univera Setting Facility Modifier None Typical Low $2,290.87 Median $2,454.71 Typical High $13,182.57 | Facility | None | $2,290.87 | $2,454.71 | $13,182.57 |
Univera Setting Professional Modifier None Typical Low $1,949.84 Median $2,290.87 Typical High $3,311.31 | Professional | None | $1,949.84 | $2,290.87 | $3,311.31 |
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 $1,445.44 Median $1,659.59 Typical High $1,659.59 | Professional | 52 · Reduced service | $1,445.44 | $1,659.59 | $1,659.59 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $575.44 Median $660.69 Typical High $660.69 | Professional | 53 · Discontinued | $575.44 | $660.69 | $660.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $2,137.96 Median $2,454.71 Typical High $2,454.71 | Professional | 54 · Surgery only | $2,137.96 | $2,454.71 | $2,454.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $436.52 Median $489.78 Typical High $489.78 | Professional | 55 · Aftercare only | $436.52 | $489.78 | $489.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $288.40 Median $331.13 Typical High $331.13 | Professional | 56 · Pre-op care only | $288.40 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,995.26 Median $2,290.87 Typical High $2,290.87 | Professional | 78 · Unplanned return to OR | $1,995.26 | $2,290.87 | $2,290.87 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $1,698.24 Median $1,995.26 Typical High $2,884.03 | Professional | 54 · Surgery only | $1,698.24 | $1,995.26 | $2,884.03 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $302.00 Typical High $426.58 | Professional | 55 · Aftercare only | $257.04 | $302.00 | $426.58 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $213.80 Median $251.19 Typical High $363.08 | Professional | 56 · Pre-op care only | $213.80 | $251.19 | $363.08 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,479.11 Median $1,737.80 Typical High $2,511.89 | Professional | 78 · Unplanned return to OR | $1,479.11 | $1,737.80 | $2,511.89 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $1,288.25 Median $1,778.28 Typical High $2,570.40 | Professional | 53 · Discontinued | $1,288.25 | $1,778.28 | $2,570.40 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $1,698.24 Median $1,995.26 Typical High $2,884.03 | Professional | 54 · Surgery only | $1,698.24 | $1,995.26 | $2,884.03 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $302.00 Typical High $645.65 | Professional | 55 · Aftercare only | $257.04 | $302.00 | $645.65 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $213.80 Median $251.19 Typical High $549.54 | Professional | 56 · Pre-op care only | $213.80 | $251.19 | $549.54 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,479.11 Median $1,737.80 Typical High $2,511.89 | Professional | 78 · Unplanned return to OR | $1,479.11 | $1,737.80 | $2,511.89 |
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 $35,907WA $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.