How much rates vary
Facilitymedian $3,090 · 10th to 90th $1,122 to $6,918Professionalmedian $389 · 10th to 90th $52 to $741
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 $616.60 Median $3,235.94 Typical High $8,511.38 | Facility | None | $616.60 | $3,235.94 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $316.23 Median $407.38 Typical High $741.31 | Professional | None | $316.23 | $407.38 | $741.31 |
Ambetter Setting Professional Modifier None Typical Low $363.08 Median $398.11 Typical High $512.86 | Professional | None | $363.08 | $398.11 | $512.86 |
BCBS Texas Setting Facility Modifier None Typical Low $1,174.90 Median $2,754.23 Typical High $7,943.28 | Facility | None | $1,174.90 | $2,754.23 | $7,943.28 |
BCBS Texas Setting Professional Modifier None Typical Low $398.11 Median $537.03 Typical High $1,000.00 | Professional | None | $398.11 | $537.03 | $1,000.00 |
Christus Setting Facility Modifier None Typical Low $3,548.13 Median $3,548.13 Typical High $3,548.13 | Facility | None | $3,548.13 | $3,548.13 | $3,548.13 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $2,041.74 Typical High $2,691.53 | Facility | None | $691.83 | $2,041.74 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $436.52 Median $562.34 Typical High $741.31 | Professional | None | $436.52 | $562.34 | $741.31 |
Health Smart Setting Facility Modifier None Typical Low $707.95 Median $707.95 Typical High $707.95 | Facility | None | $707.95 | $707.95 | $707.95 |
Lucent Health Setting Professional Modifier None Typical Low $3,715.35 Median $3,715.35 Typical High $5,011.87 | Professional | None | $3,715.35 | $3,715.35 | $5,011.87 |
Moda Health Setting Facility Modifier None Typical Low $524.81 Median $3,715.35 Typical High $9,332.54 | Facility | None | $524.81 | $3,715.35 | $9,332.54 |
Moda Health Setting Professional Modifier None Typical Low $316.23 Median $407.38 Typical High $741.31 | Professional | None | $316.23 | $407.38 | $741.31 |
Molina Setting Professional Modifier None Typical Low $14.79 Median $89.13 Typical High $501.19 | Professional | None | $14.79 | $89.13 | $501.19 |
Oscar Health Setting Professional Modifier None Typical Low $478.63 Median $954.99 Typical High $1,995.26 | Professional | None | $478.63 | $954.99 | $1,995.26 |
Providence Setting Facility Modifier None Typical Low $537.03 Median $1,995.26 Typical High $6,165.95 | Facility | None | $537.03 | $1,995.26 | $6,165.95 |
Providence Setting Professional Modifier None Typical Low $446.68 Median $562.34 Typical High $741.31 | Professional | None | $446.68 | $562.34 | $741.31 |
United Setting Facility Modifier None Typical Low $1,258.93 Median $3,467.37 Typical High $6,918.31 | Facility | None | $1,258.93 | $3,467.37 | $6,918.31 |
United Setting Professional Modifier None Typical Low $346.74 Median $478.63 Typical High $707.95 | Professional | None | $346.74 | $478.63 | $707.95 |
Wellpoint Setting Professional Modifier None Typical Low $575.44 Median $575.44 Typical High $575.44 | Professional | None | $575.44 | $575.44 | $575.44 |
14 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 $154.88 Median $199.53 Typical High $251.19 | Professional | 52 · Reduced service | $154.88 | $199.53 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $63.10 Median $79.43 Typical High $100.00 | Professional | 53 · Discontinued | $63.10 | $79.43 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $234.42 Median $295.12 Typical High $380.19 | Professional | 54 · Surgery only | $234.42 | $295.12 | $380.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $46.77 Median $58.88 Typical High $75.86 | Professional | 55 · Aftercare only | $46.77 | $58.88 | $75.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $31.62 Median $39.81 Typical High $50.12 | Professional | 56 · Pre-op care only | $31.62 | $39.81 | $50.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $218.78 Median $275.42 Typical High $354.81 | Professional | 78 · Unplanned return to OR | $218.78 | $275.42 | $354.81 |
Ambetter Setting Professional Modifier 50 · Both sides Typical Low $537.03 Median $537.03 Typical High $588.84 | Professional | 50 · Both sides | $537.03 | $537.03 | $588.84 |
Moda Health Setting Facility Modifier 50 · Both sides Typical Low $4,265.80 Median $5,495.41 Typical High $6,606.93 | Facility | 50 · Both sides | $4,265.80 | $5,495.41 | $6,606.93 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $154.88 Median $199.53 Typical High $251.19 | Professional | 52 · Reduced service | $154.88 | $199.53 | $251.19 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $63.10 Median $79.43 Typical High $100.00 | Professional | 53 · Discontinued | $63.10 | $79.43 | $100.00 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $234.42 Median $295.12 Typical High $380.19 | Professional | 54 · Surgery only | $234.42 | $295.12 | $380.19 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $46.77 Median $58.88 Typical High $75.86 | Professional | 55 · Aftercare only | $46.77 | $58.88 | $75.86 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $31.62 Median $39.81 Typical High $50.12 | Professional | 56 · Pre-op care only | $31.62 | $39.81 | $50.12 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $218.78 Median $275.42 Typical High $354.81 | Professional | 78 · Unplanned return to OR | $218.78 | $275.42 | $354.81 |
Where Texas 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.