How much rates vary
Facilitymedian $1,660 · 10th to 90th $617 to $7,762Professionalmedian $457 · 10th to 90th $105 to $813
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 $562.34 Median $1,513.56 Typical High $10,964.78 | Facility | None | $562.34 | $1,513.56 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $363.08 Median $489.78 Typical High $1,659.59 | Professional | None | $363.08 | $489.78 | $1,659.59 |
Ambetter Setting Professional Modifier None Typical Low $549.54 Median $616.60 Typical High $616.60 | Professional | None | $549.54 | $616.60 | $616.60 |
Anthem BCBS Setting Facility Modifier None Typical Low $630.96 Median $1,698.24 Typical High $7,585.78 | Facility | None | $630.96 | $1,698.24 | $7,585.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $338.84 Median $416.87 Typical High $741.31 | Professional | None | $338.84 | $416.87 | $741.31 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $489.78 Median $630.96 Typical High $1,071.52 | Professional | 50 · Both sides | $489.78 | $630.96 | $1,071.52 |
Aultcare Setting Professional Modifier None Typical Low $549.54 Median $549.54 Typical High $549.54 | Professional | None | $549.54 | $549.54 | $549.54 |
CareSource Setting Facility Modifier None Typical Low $512.86 Median $1,479.11 Typical High $1,949.84 | Facility | None | $512.86 | $1,479.11 | $1,949.84 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $1,698.24 Typical High $2,691.53 | Facility | None | $602.56 | $1,698.24 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $416.87 Median $524.81 Typical High $977.24 | Professional | None | $416.87 | $524.81 | $977.24 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $602.56 Median $1,737.80 Typical High $2,884.03 | Facility | None | $602.56 | $1,737.80 | $2,884.03 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $416.87 Median $524.81 Typical High $1,023.29 | Professional | None | $416.87 | $524.81 | $1,023.29 |
Molina Setting Professional Modifier None Typical Low $81.28 Median $457.09 Typical High $758.58 | Professional | None | $81.28 | $457.09 | $758.58 |
SummaCare Setting Facility Modifier None Typical Low $831.76 Median $870.96 Typical High $977.24 | Facility | None | $831.76 | $870.96 | $977.24 |
SummaCare Setting Professional Modifier None Typical Low $416.87 Median $575.44 Typical High $891.25 | Professional | None | $416.87 | $575.44 | $891.25 |
United Setting Facility Modifier None Typical Low $691.83 Median $1,445.44 Typical High $6,165.95 | Facility | None | $691.83 | $1,445.44 | $6,165.95 |
United Setting Professional Modifier None Typical Low $331.13 Median $512.86 Typical High $954.99 | Professional | None | $331.13 | $512.86 | $954.99 |
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 $181.97 Median $223.87 Typical High $251.19 | Professional | 52 · Reduced service | $181.97 | $223.87 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $74.13 Median $89.13 Typical High $100.00 | Professional | 53 · Discontinued | $74.13 | $89.13 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $275.42 Median $338.84 Typical High $371.54 | Professional | 54 · Surgery only | $275.42 | $338.84 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $54.95 Median $67.61 Typical High $74.13 | Professional | 55 · Aftercare only | $54.95 | $67.61 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $36.31 Median $44.67 Typical High $50.12 | Professional | 56 · Pre-op care only | $36.31 | $44.67 | $50.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $257.04 Median $316.23 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $257.04 | $316.23 | $346.74 |
Where Ohio 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.