How much rates vary
Facilitymedian $5,495 · 10th to 90th $1,202 to $14,454Professionalmedian $2,188 · 10th to 90th $1,778 to $3,981
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 $2,570.40 Median $2,818.38 Typical High $2,818.38 | Professional | None | $2,570.40 | $2,818.38 | $2,818.38 |
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 $1,862.09 Median $2,187.76 Typical High $3,235.94 | Professional | None | $1,862.09 | $2,187.76 | $3,235.94 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,174.90 Median $1,380.38 Typical High $1,995.26 | Professional | 62 · Two surgeons | $1,174.90 | $1,380.38 | $1,995.26 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $295.12 Median $346.74 Typical High $512.86 | Professional | 80 · Assistant surgeon | $295.12 | $346.74 | $512.86 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $257.04 Median $302.00 Typical High $446.68 | Professional | AS · PA/NP assist | $257.04 | $302.00 | $446.68 |
CDPHP Setting Professional Modifier None Typical Low $3,162.28 Median $3,162.28 Typical High $3,162.28 | Professional | None | $3,162.28 | $3,162.28 | $3,162.28 |
Cigna Setting Facility Modifier None Typical Low $851.14 Median $1,778.28 Typical High $3,801.89 | Facility | None | $851.14 | $1,778.28 | $3,801.89 |
Cigna Setting Professional Modifier None Typical Low $2,089.30 Median $2,137.96 Typical High $5,495.41 | Professional | None | $2,089.30 | $2,137.96 | $5,495.41 |
Emblem Health Setting Facility Modifier None Typical Low $2,238.72 Median $2,691.53 Typical High $8,709.64 | Facility | None | $2,238.72 | $2,691.53 | $8,709.64 |
Emblem Health Setting Professional Modifier None Typical Low $2,137.96 Median $2,630.27 Typical High $4,073.80 | Professional | None | $2,137.96 | $2,630.27 | $4,073.80 |
Excellus BCBS Setting Professional Modifier None Typical Low $1,737.80 Median $2,041.74 Typical High $2,630.27 | Professional | None | $1,737.80 | $2,041.74 | $2,630.27 |
MVP Health Care Setting Facility Modifier None Typical Low $2,290.87 Median $5,754.40 Typical High $38,018.94 | Facility | None | $2,290.87 | $5,754.40 | $38,018.94 |
MVP Health Care Setting Professional Modifier None Typical Low $2,344.23 Median $2,818.38 Typical High $5,370.32 | Professional | None | $2,344.23 | $2,818.38 | $5,370.32 |
United Setting Facility Modifier None Typical Low $575.44 Median $1,737.80 Typical High $6,606.93 | Facility | None | $575.44 | $1,737.80 | $6,606.93 |
United Setting Professional Modifier None Typical Low $1,412.54 Median $2,754.23 Typical High $6,309.57 | Professional | None | $1,412.54 | $2,754.23 | $6,309.57 |
Univera Setting Facility Modifier None Typical Low $2,041.74 Median $2,137.96 Typical High $7,943.28 | Facility | None | $2,041.74 | $2,137.96 | $7,943.28 |
Univera Setting Professional Modifier None Typical Low $1,737.80 Median $2,041.74 Typical High $2,630.27 | Professional | None | $1,737.80 | $2,041.74 | $2,630.27 |
14 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 $1,288.25 Median $1,380.38 Typical High $1,380.38 | Professional | 52 · Reduced service | $1,288.25 | $1,380.38 | $1,380.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $512.86 Median $562.34 Typical High $562.34 | Professional | 53 · Discontinued | $512.86 | $562.34 | $562.34 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,905.46 Median $2,089.30 Typical High $2,089.30 | Professional | 54 · Surgery only | $1,905.46 | $2,089.30 | $2,089.30 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $380.19 Median $416.87 Typical High $416.87 | Professional | 55 · Aftercare only | $380.19 | $416.87 | $416.87 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $257.04 Median $281.84 Typical High $281.84 | Professional | 56 · Pre-op care only | $257.04 | $281.84 | $281.84 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,778.28 Median $1,949.84 Typical High $1,949.84 | Professional | 78 · Unplanned return to OR | $1,778.28 | $1,949.84 | $1,949.84 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $1,513.56 Median $1,778.28 Typical High $2,290.87 | Professional | 54 · Surgery only | $1,513.56 | $1,778.28 | $2,290.87 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $263.03 Typical High $346.74 | Professional | 55 · Aftercare only | $223.87 | $263.03 | $346.74 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $190.55 Median $223.87 Typical High $295.12 | Professional | 56 · Pre-op care only | $190.55 | $223.87 | $295.12 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,318.26 Median $1,548.82 Typical High $1,995.26 | Professional | 78 · Unplanned return to OR | $1,318.26 | $1,548.82 | $1,995.26 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $1,513.56 Median $1,778.28 Typical High $2,290.87 | Professional | 54 · Surgery only | $1,513.56 | $1,778.28 | $2,290.87 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $223.87 Median $263.03 Typical High $758.58 | Professional | 55 · Aftercare only | $223.87 | $263.03 | $758.58 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $190.55 Median $223.87 Typical High $645.65 | Professional | 56 · Pre-op care only | $190.55 | $223.87 | $645.65 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,318.26 Median $1,548.82 Typical High $2,137.96 | Professional | 78 · Unplanned return to OR | $1,318.26 | $1,548.82 | $2,137.96 |
Where New York sits
The same service costs 13.8 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 $35,114TX $2,545
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.