How much rates vary
Facilitymedian $5,248 · 10th to 90th $1,175 to $14,125Professionalmedian $1,514 · 10th to 90th $1,230 to $3,388
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 $1,698.24 Median $1,905.46 Typical High $4,168.69 | Professional | None | $1,698.24 | $1,905.46 | $4,168.69 |
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 $1,258.93 Median $1,479.11 Typical High $3,019.95 | Professional | None | $1,258.93 | $1,479.11 | $3,019.95 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $794.33 Median $933.25 Typical High $1,862.09 | Professional | 62 · Two surgeons | $794.33 | $933.25 | $1,862.09 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $199.53 Median $234.42 Typical High $478.63 | Professional | 80 · Assistant surgeon | $199.53 | $234.42 | $478.63 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $173.78 Median $204.17 Typical High $416.87 | Professional | AS · PA/NP assist | $173.78 | $204.17 | $416.87 |
CDPHP Setting Professional Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $2,089.30 | Professional | None | $2,089.30 | $2,089.30 | $2,089.30 |
Cigna Setting Facility Modifier None Typical Low $851.14 Median $1,778.28 Typical High $2,754.23 | Facility | None | $851.14 | $1,778.28 | $2,754.23 |
Cigna Setting Professional Modifier None Typical Low $1,445.44 Median $1,819.70 Typical High $7,762.47 | Professional | None | $1,445.44 | $1,819.70 | $7,762.47 |
Emblem Health Setting Facility Modifier None Typical Low $1,174.90 Median $1,862.09 Typical High $5,888.44 | Facility | None | $1,174.90 | $1,862.09 | $5,888.44 |
Emblem Health Setting Professional Modifier None Typical Low $1,737.80 Median $1,995.26 Typical High $3,467.37 | Professional | None | $1,737.80 | $1,995.26 | $3,467.37 |
Excellus BCBS Setting Professional Modifier None Typical Low $1,148.15 Median $1,380.38 Typical High $1,949.84 | Professional | None | $1,148.15 | $1,380.38 | $1,949.84 |
MVP Health Care Setting Facility Modifier None Typical Low $1,513.56 Median $1,513.56 Typical High $1,513.56 | Facility | None | $1,513.56 | $1,513.56 | $1,513.56 |
MVP Health Care Setting Professional Modifier None Typical Low $1,621.81 Median $1,621.81 Typical High $3,981.07 | Professional | None | $1,621.81 | $1,621.81 | $3,981.07 |
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 $1,318.26 Median $2,041.74 Typical High $4,786.30 | Professional | None | $1,318.26 | $2,041.74 | $4,786.30 |
Univera Setting Facility Modifier None Typical Low $1,348.96 Median $1,445.44 Typical High $5,248.07 | Facility | None | $1,348.96 | $1,445.44 | $5,248.07 |
Univera Setting Professional Modifier None Typical Low $1,148.15 Median $1,380.38 Typical High $1,949.84 | Professional | None | $1,148.15 | $1,380.38 | $1,949.84 |
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 $851.14 Median $954.99 Typical High $954.99 | Professional | 52 · Reduced service | $851.14 | $954.99 | $954.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $338.84 Median $389.05 Typical High $389.05 | Professional | 53 · Discontinued | $338.84 | $389.05 | $389.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,288.25 Median $1,445.44 Typical High $1,445.44 | Professional | 54 · Surgery only | $1,288.25 | $1,445.44 | $1,445.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $257.04 Median $288.40 Typical High $288.40 | Professional | 55 · Aftercare only | $257.04 | $288.40 | $288.40 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $169.82 Median $190.55 Typical High $190.55 | Professional | 56 · Pre-op care only | $169.82 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,202.26 Median $1,348.96 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $1,202.26 | $1,348.96 | $1,348.96 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,202.26 Typical High $1,778.28 | Professional | 54 · Surgery only | $1,000.00 | $1,202.26 | $1,778.28 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $181.97 Typical High $269.15 | Professional | 55 · Aftercare only | $151.36 | $181.97 | $269.15 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $151.36 Typical High $229.09 | Professional | 56 · Pre-op care only | $125.89 | $151.36 | $229.09 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $1,047.13 Typical High $1,584.89 | Professional | 78 · Unplanned return to OR | $870.96 | $1,047.13 | $1,584.89 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $741.31 Median $1,023.29 Typical High $1,584.89 | Professional | 53 · Discontinued | $741.31 | $1,023.29 | $1,584.89 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $1,000.00 Median $1,202.26 Typical High $1,698.24 | Professional | 54 · Surgery only | $1,000.00 | $1,202.26 | $1,698.24 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $151.36 Median $181.97 Typical High $380.19 | Professional | 55 · Aftercare only | $151.36 | $181.97 | $380.19 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $151.36 Typical High $323.59 | Professional | 56 · Pre-op care only | $125.89 | $151.36 | $323.59 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $870.96 Median $1,047.13 Typical High $1,479.11 | Professional | 78 · Unplanned return to OR | $870.96 | $1,047.13 | $1,479.11 |
Where New York sits
The same service costs 15.5 times more in Maine than in Maryland. 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 $34,449MD $2,222
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.