How much rates vary
Facilitymedian $3,631 · 10th to 90th $631 to $12,589Professionalmedian $501 · 10th to 90th $372 to $776
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 $407.38 Median $630.96 Typical High $8,128.31 | Facility | None | $407.38 | $630.96 | $8,128.31 |
Aetna Setting Professional Modifier None Typical Low $338.84 Median $426.58 Typical High $707.95 | Professional | None | $338.84 | $426.58 | $707.95 |
Ambetter Setting Professional Modifier None Typical Low $562.34 Median $562.34 Typical High $562.34 | Professional | None | $562.34 | $562.34 | $562.34 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,047.13 Median $7,413.10 Typical High $16,218.10 | Facility | None | $1,047.13 | $7,413.10 | $16,218.10 |
Anthem BCBS Setting Professional Modifier None Typical Low $389.05 Median $501.19 Typical High $776.25 | Professional | None | $389.05 | $501.19 | $776.25 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $588.84 Median $758.58 Typical High $1,148.15 | Professional | 50 · Both sides | $588.84 | $758.58 | $1,148.15 |
CareSource Setting Facility Modifier None Typical Low $426.58 Median $426.58 Typical High $3,162.28 | Facility | None | $426.58 | $426.58 | $3,162.28 |
Cigna Setting Facility Modifier None Typical Low $630.96 Median $2,691.53 Typical High $8,128.31 | Facility | None | $630.96 | $2,691.53 | $8,128.31 |
Cigna Setting Professional Modifier None Typical Low $407.38 Median $524.81 Typical High $812.83 | Professional | None | $407.38 | $524.81 | $812.83 |
Physicians Health Plan of Northern Indiana Setting Facility Modifier None Typical Low $1,122.02 Median $2,754.23 Typical High $5,495.41 | Facility | None | $1,122.02 | $2,754.23 | $5,495.41 |
Physicians Health Plan of Northern Indiana Setting Professional Modifier None Typical Low $457.09 Median $616.60 Typical High $891.25 | Professional | None | $457.09 | $616.60 | $891.25 |
United Setting Facility Modifier None Typical Low $1,000.00 Median $3,311.31 Typical High $7,943.28 | Facility | None | $1,000.00 | $3,311.31 | $7,943.28 |
United Setting Professional Modifier None Typical Low $371.54 Median $501.19 Typical High $776.25 | Professional | None | $371.54 | $501.19 | $776.25 |
6 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 $169.82 Median $213.80 Typical High $251.19 | Professional | 52 · Reduced service | $169.82 | $213.80 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $67.61 Median $85.11 Typical High $100.00 | Professional | 53 · Discontinued | $67.61 | $85.11 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $257.04 Median $316.23 Typical High $371.54 | Professional | 54 · Surgery only | $257.04 | $316.23 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $51.29 Median $64.57 Typical High $74.13 | Professional | 55 · Aftercare only | $51.29 | $64.57 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $33.88 Median $42.66 Typical High $50.12 | Professional | 56 · Pre-op care only | $33.88 | $42.66 | $50.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $239.88 Median $295.12 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $239.88 | $295.12 | $346.74 |
Where Indiana sits
The same service costs 7.2 times more in Vermont than in Maine. 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
VT $9,370ME $1,294
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.