How much rates vary
Facilitymedian $3,802 · 10th to 90th $661 to $9,550Professionalmedian $447 · 10th to 90th $355 to $1,096
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 $2,951.21 Typical High $8,317.64 | Facility | None | $407.38 | $2,951.21 | $8,317.64 |
Aetna Setting Professional Modifier None Typical Low $363.08 Median $436.52 Typical High $1,000.00 | Professional | None | $363.08 | $436.52 | $1,000.00 |
Ambetter Setting Professional Modifier None Typical Low $724.44 Median $724.44 Typical High $724.44 | Professional | None | $724.44 | $724.44 | $724.44 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,513.56 Median $4,466.84 Typical High $10,964.78 | Facility | None | $1,513.56 | $4,466.84 | $10,964.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $380.19 Median $446.68 Typical High $954.99 | Professional | None | $380.19 | $446.68 | $954.99 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $575.44 Median $676.08 Typical High $1,412.54 | Professional | 50 · Both sides | $575.44 | $676.08 | $1,412.54 |
CDPHP Setting Facility Modifier None Typical Low $1,905.46 Median $2,951.21 Typical High $8,912.51 | Facility | None | $1,905.46 | $2,951.21 | $8,912.51 |
CDPHP Setting Professional Modifier None Typical Low $588.84 Median $588.84 Typical High $724.44 | Professional | None | $588.84 | $588.84 | $724.44 |
Cigna Setting Facility Modifier None Typical Low $1,318.26 Median $2,691.53 Typical High $5,370.32 | Facility | None | $1,318.26 | $2,691.53 | $5,370.32 |
Cigna Setting Professional Modifier None Typical Low $346.74 Median $436.52 Typical High $1,862.09 | Professional | None | $346.74 | $436.52 | $1,862.09 |
Emblem Health Setting Facility Modifier None Typical Low $446.68 Median $575.44 Typical High $1,698.24 | Facility | None | $446.68 | $575.44 | $1,698.24 |
Emblem Health Setting Professional Modifier None Typical Low $630.96 Median $724.44 Typical High $1,202.26 | Professional | None | $630.96 | $724.44 | $1,202.26 |
Excellus BCBS Setting Professional Modifier None Typical Low $363.08 Median $501.19 Typical High $977.24 | Professional | None | $363.08 | $501.19 | $977.24 |
Highmark BCBS Setting Facility Modifier None Typical Low $2,290.87 Median $5,370.32 Typical High $11,220.18 | Facility | None | $2,290.87 | $5,370.32 | $11,220.18 |
Highmark BCBS Setting Professional Modifier None Typical Low $489.78 Median $602.56 Typical High $776.25 | Professional | None | $489.78 | $602.56 | $776.25 |
MVP Health Care Setting Facility Modifier None Typical Low $398.11 Median $4,365.16 Typical High $23,442.29 | Facility | None | $398.11 | $4,365.16 | $23,442.29 |
MVP Health Care Setting Professional Modifier None Typical Low $363.08 Median $363.08 Typical High $1,202.26 | Professional | None | $363.08 | $363.08 | $1,202.26 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $2,754.23 Typical High $8,709.64 | Facility | None | $1,148.15 | $2,754.23 | $8,709.64 |
United Setting Professional Modifier None Typical Low $295.12 Median $478.63 Typical High $1,288.25 | Professional | None | $295.12 | $478.63 | $1,288.25 |
Univera Setting Facility Modifier None Typical Low $309.03 Median $478.63 Typical High $1,348.96 | Facility | None | $309.03 | $478.63 | $1,348.96 |
Univera Setting Professional Modifier None Typical Low $363.08 Median $501.19 Typical High $954.99 | Professional | None | $363.08 | $501.19 | $954.99 |
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 $181.97 Median $218.78 Typical High $263.03 | Professional | 52 · Reduced service | $181.97 | $218.78 | $263.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $74.13 Median $87.10 Typical High $104.71 | Professional | 53 · Discontinued | $74.13 | $87.10 | $104.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $275.42 Median $323.59 Typical High $398.11 | Professional | 54 · Surgery only | $275.42 | $323.59 | $398.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $54.95 Median $64.57 Typical High $79.43 | Professional | 55 · Aftercare only | $54.95 | $64.57 | $79.43 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $36.31 Median $43.65 Typical High $52.48 | Professional | 56 · Pre-op care only | $36.31 | $43.65 | $52.48 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $257.04 Median $302.00 Typical High $371.54 | Professional | 78 · Unplanned return to OR | $257.04 | $302.00 | $371.54 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $346.74 Median $436.52 Typical High $870.96 | Professional | 54 · Surgery only | $346.74 | $436.52 | $870.96 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $102.33 Typical High $128.82 | Professional | 55 · Aftercare only | $66.07 | $102.33 | $128.82 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $53.70 Typical High $67.61 | Professional | 56 · Pre-op care only | $34.67 | $53.70 | $67.61 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $389.05 Typical High $812.83 | Professional | 78 · Unplanned return to OR | $302.00 | $389.05 | $812.83 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $346.74 Typical High $524.81 | Professional | 53 · Discontinued | $251.19 | $346.74 | $524.81 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $346.74 Median $436.52 Typical High $851.14 | Professional | 54 · Surgery only | $346.74 | $436.52 | $851.14 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $102.33 Typical High $194.98 | Professional | 55 · Aftercare only | $66.07 | $102.33 | $194.98 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $53.70 Typical High $102.33 | Professional | 56 · Pre-op care only | $34.67 | $53.70 | $102.33 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $389.05 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $302.00 | $389.05 | $794.33 |
Where New York 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.