How much rates vary
Facilitymedian $3,890 · 10th to 90th $1,023 to $10,000Professionalmedian $1,000 · 10th to 90th $813 to $2,188
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 $6,309.57 Typical High $12,302.69 | Facility | None | $1,819.70 | $6,309.57 | $12,302.69 |
Aetna Setting Professional Modifier None Typical Low $1,096.48 Median $1,288.25 Typical High $2,290.87 | Professional | None | $1,096.48 | $1,288.25 | $2,290.87 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,548.82 Median $4,466.84 Typical High $10,964.78 | Facility | None | $1,548.82 | $4,466.84 | $10,964.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $831.76 Median $977.24 Typical High $1,949.84 | Professional | None | $831.76 | $977.24 | $1,949.84 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $524.81 Median $616.60 Typical High $1,230.27 | Professional | 62 · Two surgeons | $524.81 | $616.60 | $1,230.27 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $131.83 Median $154.88 Typical High $316.23 | Professional | 80 · Assistant surgeon | $131.83 | $154.88 | $316.23 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $117.49 Median $138.04 Typical High $275.42 | Professional | AS · PA/NP assist | $117.49 | $138.04 | $275.42 |
CDPHP Setting Professional Modifier None Typical Low $1,380.38 Median $1,380.38 Typical High $1,380.38 | Professional | None | $1,380.38 | $1,380.38 | $1,380.38 |
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 $912.01 Median $1,174.90 Typical High $5,370.32 | Professional | None | $912.01 | $1,174.90 | $5,370.32 |
Emblem Health Setting Facility Modifier None Typical Low $1,122.02 Median $2,238.72 Typical High $4,073.80 | Facility | None | $1,122.02 | $2,238.72 | $4,073.80 |
Emblem Health Setting Professional Modifier None Typical Low $1,122.02 Median $1,288.25 Typical High $2,089.30 | Professional | None | $1,122.02 | $1,288.25 | $2,089.30 |
Excellus BCBS Setting Professional Modifier None Typical Low $741.31 Median $891.25 Typical High $1,230.27 | Professional | None | $741.31 | $891.25 | $1,230.27 |
MVP Health Care Setting Facility Modifier None Typical Low $1,023.29 Median $5,754.40 Typical High $58,884.37 | Facility | None | $1,023.29 | $5,754.40 | $58,884.37 |
MVP Health Care Setting Professional Modifier None Typical Low $1,348.96 Median $1,348.96 Typical High $2,570.40 | Professional | None | $1,348.96 | $1,348.96 | $2,570.40 |
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 $851.14 Median $1,318.26 Typical High $3,162.28 | Professional | None | $851.14 | $1,318.26 | $3,162.28 |
Univera Setting Facility Modifier None Typical Low $870.96 Median $933.25 Typical High $4,677.35 | Facility | None | $870.96 | $933.25 | $4,677.35 |
Univera Setting Professional Modifier None Typical Low $741.31 Median $891.25 Typical High $1,230.27 | Professional | None | $741.31 | $891.25 | $1,230.27 |
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 $549.54 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $549.54 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $218.78 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $218.78 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $831.76 Median $977.24 Typical High $977.24 | Professional | 54 · Surgery only | $831.76 | $977.24 | $977.24 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $165.96 Median $194.98 Typical High $194.98 | Professional | 55 · Aftercare only | $165.96 | $194.98 | $194.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $128.82 Typical High $128.82 | Professional | 56 · Pre-op care only | $109.65 | $128.82 | $128.82 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $776.25 Median $912.01 Typical High $912.01 | Professional | 78 · Unplanned return to OR | $776.25 | $912.01 | $912.01 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $645.65 Median $776.25 Typical High $1,148.15 | Professional | 54 · Surgery only | $645.65 | $776.25 | $1,148.15 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $117.49 Typical High $173.78 | Professional | 55 · Aftercare only | $95.50 | $117.49 | $173.78 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $100.00 Typical High $144.54 | Professional | 56 · Pre-op care only | $81.28 | $100.00 | $144.54 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $691.83 Typical High $1,000.00 | Professional | 78 · Unplanned return to OR | $562.34 | $691.83 | $1,000.00 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $489.78 Median $676.08 Typical High $1,023.29 | Professional | 53 · Discontinued | $489.78 | $676.08 | $1,023.29 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $645.65 Median $776.25 Typical High $1,071.52 | Professional | 54 · Surgery only | $645.65 | $776.25 | $1,071.52 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $95.50 Median $117.49 Typical High $245.47 | Professional | 55 · Aftercare only | $95.50 | $117.49 | $245.47 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $81.28 Median $100.00 Typical High $208.93 | Professional | 56 · Pre-op care only | $81.28 | $100.00 | $208.93 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $562.34 Median $691.83 Typical High $933.25 | Professional | 78 · Unplanned return to OR | $562.34 | $691.83 | $933.25 |
Where New York sits
The same service costs 9.8 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 $16,204MD $1,659
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.