How much rates vary
Facilitymedian $5,370 · 10th to 90th $1,230 to $14,454Professionalmedian $1,905 · 10th to 90th $1,318 to $2,512
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 $1,584.89 Median $1,737.80 Typical High $1,737.80 | Professional | None | $1,584.89 | $1,737.80 | $1,737.80 |
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 $1,819.70 Median $2,137.96 Typical High $2,398.83 | Professional | None | $1,819.70 | $2,137.96 | $2,398.83 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $1,148.15 Median $1,348.96 Typical High $1,479.11 | Professional | 62 · Two surgeons | $1,148.15 | $1,348.96 | $1,479.11 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $288.40 Median $338.84 Typical High $380.19 | Professional | 80 · Assistant surgeon | $288.40 | $338.84 | $380.19 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $257.04 Median $302.00 Typical High $331.13 | Professional | AS · PA/NP assist | $257.04 | $302.00 | $331.13 |
CDPHP Setting Professional Modifier None Typical Low $1,949.84 Median $1,949.84 Typical High $1,949.84 | Professional | None | $1,949.84 | $1,949.84 | $1,949.84 |
Cigna Setting Facility Modifier None Typical Low $1,288.25 Median $2,691.53 Typical High $6,025.60 | Facility | None | $1,288.25 | $2,691.53 | $6,025.60 |
Cigna Setting Professional Modifier None Typical Low $1,348.96 Median $1,380.38 Typical High $3,467.37 | Professional | None | $1,348.96 | $1,380.38 | $3,467.37 |
Emblem Health Setting Facility Modifier None Typical Low $1,548.82 Median $3,019.95 Typical High $5,888.44 | Facility | None | $1,548.82 | $3,019.95 | $5,888.44 |
Emblem Health Setting Professional Modifier None Typical Low $1,348.96 Median $1,698.24 Typical High $2,630.27 | Professional | None | $1,348.96 | $1,698.24 | $2,630.27 |
Excellus BCBS Setting Professional Modifier None Typical Low $1,071.52 Median $1,288.25 Typical High $1,778.28 | Professional | None | $1,071.52 | $1,288.25 | $1,778.28 |
MVP Health Care Setting Facility Modifier None Typical Low $1,380.38 Median $5,754.40 Typical High $38,018.94 | Facility | None | $1,380.38 | $5,754.40 | $38,018.94 |
MVP Health Care Setting Professional Modifier None Typical Low $1,445.44 Median $1,905.46 Typical High $3,630.78 | Professional | None | $1,445.44 | $1,905.46 | $3,630.78 |
United Setting Facility Modifier None Typical Low $575.44 Median $1,778.28 Typical High $6,606.93 | Facility | None | $575.44 | $1,778.28 | $6,606.93 |
United Setting Professional Modifier None Typical Low $933.25 Median $1,698.24 Typical High $3,981.07 | Professional | None | $933.25 | $1,698.24 | $3,981.07 |
Univera Setting Facility Modifier None Typical Low $1,258.93 Median $1,348.96 Typical High $6,025.60 | Facility | None | $1,258.93 | $1,348.96 | $6,025.60 |
Univera Setting Professional Modifier None Typical Low $1,071.52 Median $1,288.25 Typical High $1,778.28 | Professional | None | $1,071.52 | $1,288.25 | $1,778.28 |
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 $794.33 Median $870.96 Typical High $870.96 | Professional | 52 · Reduced service | $794.33 | $870.96 | $870.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $346.74 Typical High $346.74 | Professional | 53 · Discontinued | $316.23 | $346.74 | $346.74 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,202.26 Median $1,288.25 Typical High $1,288.25 | Professional | 54 · Surgery only | $1,202.26 | $1,288.25 | $1,288.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $239.88 Median $263.03 Typical High $263.03 | Professional | 55 · Aftercare only | $239.88 | $263.03 | $263.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $158.49 Median $173.78 Typical High $173.78 | Professional | 56 · Pre-op care only | $158.49 | $173.78 | $173.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,122.02 Median $1,202.26 Typical High $1,202.26 | Professional | 78 · Unplanned return to OR | $1,122.02 | $1,202.26 | $1,202.26 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $1,122.02 Typical High $1,548.82 | Professional | 54 · Surgery only | $933.25 | $1,122.02 | $1,548.82 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $138.04 Median $169.82 Typical High $234.42 | Professional | 55 · Aftercare only | $138.04 | $169.82 | $234.42 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $117.49 Median $141.25 Typical High $199.53 | Professional | 56 · Pre-op care only | $117.49 | $141.25 | $199.53 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $812.83 Median $977.24 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $812.83 | $977.24 | $1,348.96 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $724.44 Median $724.44 Typical High $1,071.52 | Professional | 53 · Discontinued | $724.44 | $724.44 | $1,071.52 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $933.25 Median $1,122.02 Typical High $1,548.82 | Professional | 54 · Surgery only | $933.25 | $1,122.02 | $1,548.82 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $138.04 Median $169.82 Typical High $457.09 | Professional | 55 · Aftercare only | $138.04 | $169.82 | $457.09 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $117.49 Median $141.25 Typical High $389.05 | Professional | 56 · Pre-op care only | $117.49 | $141.25 | $389.05 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $812.83 Median $977.24 Typical High $1,348.96 | Professional | 78 · Unplanned return to OR | $812.83 | $977.24 | $1,348.96 |
Where New York sits
The same service costs 16.4 times more in Maine than in Delaware. 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 $34,058DE $2,083
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.