How much rates vary
Facilitymedian $1,862 · 10th to 90th $437 to $7,244Professionalmedian $417 · 10th to 90th $339 to $692
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 $354.81 Median $489.78 Typical High $851.14 | Facility | None | $354.81 | $489.78 | $851.14 |
Aetna Setting Professional Modifier None Typical Low $354.81 Median $436.52 Typical High $776.25 | Professional | None | $354.81 | $436.52 | $776.25 |
Ambetter Setting Professional Modifier None Typical Low $501.19 Median $501.19 Typical High $537.03 | Professional | None | $501.19 | $501.19 | $537.03 |
Anthem BCBS Setting Facility Modifier None Typical Low $954.99 Median $2,884.03 Typical High $8,511.38 | Facility | None | $954.99 | $2,884.03 | $8,511.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $316.23 Median $416.87 Typical High $588.84 | Professional | None | $316.23 | $416.87 | $588.84 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $478.63 Median $630.96 Typical High $870.96 | Professional | 50 · Both sides | $478.63 | $630.96 | $870.96 |
CareSource Setting Facility Modifier None Typical Low $371.54 Median $616.60 Typical High $2,570.40 | Facility | None | $371.54 | $616.60 | $2,570.40 |
CareSource Setting Professional Modifier None Typical Low $389.05 Median $537.03 Typical High $645.65 | Professional | None | $389.05 | $537.03 | $645.65 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,819.70 Typical High $1,905.46 | Facility | None | $707.95 | $1,819.70 | $1,905.46 |
Cigna Setting Professional Modifier None Typical Low $398.11 Median $524.81 Typical High $2,754.23 | Professional | None | $398.11 | $524.81 | $2,754.23 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
United Setting Facility Modifier None Typical Low $707.95 Median $1,174.90 Typical High $3,890.45 | Facility | None | $707.95 | $1,174.90 | $3,890.45 |
United Setting Professional Modifier None Typical Low $338.84 Median $436.52 Typical High $851.14 | Professional | None | $338.84 | $436.52 | $851.14 |
12 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 Facility Modifier 52 · Reduced service Typical Low $177.83 Median $218.78 Typical High $245.47 | Facility | 52 · Reduced service | $177.83 | $218.78 | $245.47 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $70.79 Median $87.10 Typical High $97.72 | Facility | 53 · Discontinued | $70.79 | $87.10 | $97.72 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $269.15 Median $323.59 Typical High $371.54 | Facility | 54 · Surgery only | $269.15 | $323.59 | $371.54 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $53.70 Median $64.57 Typical High $74.13 | Facility | 55 · Aftercare only | $53.70 | $64.57 | $74.13 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $35.48 Median $43.65 Typical High $48.98 | Facility | 56 · Pre-op care only | $35.48 | $43.65 | $48.98 |
Aetna Setting Facility Modifier 78 · Unplanned return to OR Typical Low $251.19 Median $302.00 Typical High $346.74 | Facility | 78 · Unplanned return to OR | $251.19 | $302.00 | $346.74 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $177.83 Median $213.80 Typical High $245.47 | Professional | 52 · Reduced service | $177.83 | $213.80 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $70.79 Median $85.11 Typical High $97.72 | Professional | 53 · Discontinued | $70.79 | $85.11 | $97.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $269.15 Median $323.59 Typical High $371.54 | Professional | 54 · Surgery only | $269.15 | $323.59 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $53.70 Median $64.57 Typical High $74.13 | Professional | 55 · Aftercare only | $53.70 | $64.57 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $35.48 Median $42.66 Typical High $48.98 | Professional | 56 · Pre-op care only | $35.48 | $42.66 | $48.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $251.19 Median $302.00 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $251.19 | $302.00 | $346.74 |
Where Kentucky 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.