How much rates vary
Facilitymedian $2,570 · 10th to 90th $302 to $5,012Professionalmedian $257 · 10th to 90th $98 to $355
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 $616.60 Median $4,168.69 Typical High $8,128.31 | Facility | None | $616.60 | $4,168.69 | $8,128.31 |
Aetna Setting Professional Modifier None Typical Low $138.04 Median $269.15 Typical High $380.19 | Professional | None | $138.04 | $269.15 | $380.19 |
Anthem BCBS Setting Facility Modifier None Typical Low $933.25 Median $3,162.28 Typical High $4,897.79 | Facility | None | $933.25 | $3,162.28 | $4,897.79 |
Anthem BCBS Setting Professional Modifier None Typical Low $245.47 Median $288.40 Typical High $363.08 | Professional | None | $245.47 | $288.40 | $363.08 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $363.08 Median $426.58 Typical High $537.03 | Professional | 50 · Both sides | $363.08 | $426.58 | $537.03 |
CDPHP Setting Facility Modifier None Typical Low $2,089.30 Median $2,089.30 Typical High $6,165.95 | Facility | None | $2,089.30 | $2,089.30 | $6,165.95 |
CDPHP Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $398.11 | Professional | None | $162.18 | $162.18 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $100.00 Median $302.00 Typical High $602.56 | Facility | None | $100.00 | $302.00 | $602.56 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $229.09 Typical High $407.38 | Professional | None | $93.33 | $229.09 | $407.38 |
Emblem Health Setting Facility Modifier None Typical Low $34.67 Median $114.82 Typical High $389.05 | Facility | None | $34.67 | $114.82 | $389.05 |
Emblem Health Setting Professional Modifier None Typical Low $251.19 Median $302.00 Typical High $457.09 | Professional | None | $251.19 | $302.00 | $457.09 |
Excellus BCBS Setting Professional Modifier None Typical Low $141.25 Median $223.87 Typical High $338.84 | Professional | None | $141.25 | $223.87 | $338.84 |
Highmark BCBS Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $346.74 | Professional | None | $323.59 | $323.59 | $346.74 |
MVP Health Care Setting Facility Modifier None Typical Low $107.15 Median $107.15 Typical High $107.15 | Facility | None | $107.15 | $107.15 | $107.15 |
MVP Health Care Setting Professional Modifier None Typical Low $83.18 Median $83.18 Typical High $380.19 | Professional | None | $83.18 | $83.18 | $380.19 |
United Setting Facility Modifier None Typical Low $363.08 Median $1,148.15 Typical High $4,365.16 | Facility | None | $363.08 | $1,148.15 | $4,365.16 |
United Setting Professional Modifier None Typical Low $89.13 Median $186.21 Typical High $316.23 | Professional | None | $89.13 | $186.21 | $316.23 |
Univera Setting Facility Modifier None Typical Low $109.65 Median $251.19 Typical High $331.13 | Facility | None | $109.65 | $251.19 | $331.13 |
Univera Setting Professional Modifier None Typical Low $141.25 Median $239.88 Typical High $338.84 | Professional | None | $141.25 | $239.88 | $338.84 |
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 $69.18 Median $117.49 Typical High $165.96 | Professional | 52 · Reduced service | $69.18 | $117.49 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $27.54 Median $46.77 Typical High $67.61 | Professional | 53 · Discontinued | $27.54 | $46.77 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $177.83 Typical High $251.19 | Professional | 54 · Surgery only | $102.33 | $177.83 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $35.48 Typical High $50.12 | Professional | 55 · Aftercare only | $20.42 | $35.48 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $23.44 Typical High $33.88 | Professional | 56 · Pre-op care only | $13.80 | $23.44 | $33.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $95.50 Median $165.96 Typical High $234.42 | Professional | 78 · Unplanned return to OR | $95.50 | $165.96 | $234.42 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $186.21 Median $218.78 Typical High $302.00 | Professional | 54 · Surgery only | $186.21 | $218.78 | $302.00 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $23.99 Typical High $33.88 | Professional | 55 · Aftercare only | $20.42 | $23.99 | $33.88 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $23.99 Typical High $33.88 | Professional | 56 · Pre-op care only | $20.42 | $23.99 | $33.88 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $194.98 Typical High $269.15 | Professional | 78 · Unplanned return to OR | $165.96 | $194.98 | $269.15 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $128.82 Median $158.49 Typical High $223.87 | Professional | 53 · Discontinued | $128.82 | $158.49 | $223.87 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $186.21 Median $218.78 Typical High $302.00 | Professional | 54 · Surgery only | $186.21 | $218.78 | $302.00 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $23.99 Typical High $50.12 | Professional | 55 · Aftercare only | $20.42 | $23.99 | $50.12 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $23.99 Typical High $50.12 | Professional | 56 · Pre-op care only | $20.42 | $23.99 | $50.12 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $165.96 Median $194.98 Typical High $269.15 | Professional | 78 · Unplanned return to OR | $165.96 | $194.98 | $269.15 |
Where New York sits
The same service costs 4.6 times more in Wisconsin than in Kentucky. 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.
New York· 15th of 51
$263
WI $513KY $112
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.