How much rates vary
Facilitymedian $3,020 · 10th to 90th $525 to $8,511Professionalmedian $437 · 10th to 90th $302 to $1,000
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 $5,128.61 Typical High $10,232.93 | Facility | None | $354.81 | $5,128.61 | $10,232.93 |
Aetna Setting Professional Modifier None Typical Low $302.00 Median $407.38 Typical High $870.96 | Professional | None | $302.00 | $407.38 | $870.96 |
Ambetter Setting Professional Modifier None Typical Low $446.68 Median $446.68 Typical High $562.34 | Professional | None | $446.68 | $446.68 | $562.34 |
AmeriHealth Setting Facility Modifier None Typical Low $1,819.70 Median $1,949.84 Typical High $3,467.37 | Facility | None | $1,819.70 | $1,949.84 | $3,467.37 |
AmeriHealth Setting Professional Modifier None Typical Low $776.25 Median $776.25 Typical High $776.25 | Professional | None | $776.25 | $776.25 | $776.25 |
Cigna Setting Facility Modifier None Typical Low $1,174.90 Median $2,511.89 Typical High $3,630.78 | Facility | None | $1,174.90 | $2,511.89 | $3,630.78 |
Cigna Setting Professional Modifier None Typical Low $338.84 Median $446.68 Typical High $1,071.52 | Professional | None | $338.84 | $446.68 | $1,071.52 |
Emblem Health Setting Professional Modifier None Typical Low $630.96 Median $933.25 Typical High $933.25 | Professional | None | $630.96 | $933.25 | $933.25 |
Horizon BCBS Setting Facility Modifier None Typical Low $2,290.87 Median $4,365.16 Typical High $14,791.08 | Facility | None | $2,290.87 | $4,365.16 | $14,791.08 |
Horizon BCBS Setting Professional Modifier None Typical Low $398.11 Median $575.44 Typical High $1,445.44 | Professional | None | $398.11 | $575.44 | $1,445.44 |
United Setting Facility Modifier None Typical Low $1,122.02 Median $2,884.03 Typical High $6,918.31 | Facility | None | $1,122.02 | $2,884.03 | $6,918.31 |
United Setting Professional Modifier None Typical Low $251.19 Median $398.11 Typical High $977.24 | Professional | None | $251.19 | $398.11 | $977.24 |
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 $151.36 Median $177.83 Typical High $218.78 | Professional | 52 · Reduced service | $151.36 | $177.83 | $218.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $60.26 Median $70.79 Typical High $87.10 | Professional | 53 · Discontinued | $60.26 | $70.79 | $87.10 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $223.87 Median $263.03 Typical High $323.59 | Professional | 54 · Surgery only | $223.87 | $263.03 | $323.59 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $44.67 Median $53.70 Typical High $64.57 | Professional | 55 · Aftercare only | $44.67 | $53.70 | $64.57 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $30.20 Median $35.48 Typical High $43.65 | Professional | 56 · Pre-op care only | $30.20 | $35.48 | $43.65 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $208.93 Median $245.47 Typical High $302.00 | Professional | 78 · Unplanned return to OR | $208.93 | $245.47 | $302.00 |
Where New Jersey 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.