How much rates vary
Facilitymedian $1,585 · 10th to 90th $550 to $5,248Professionalmedian $813 · 10th to 90th $457 to $1,349
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 $457.09 Median $562.34 Typical High $2,818.38 | Facility | None | $457.09 | $562.34 | $2,818.38 |
Aetna Setting Professional Modifier None Typical Low $446.68 Median $562.34 Typical High $891.25 | Professional | None | $446.68 | $562.34 | $891.25 |
Ambetter Setting Professional Modifier None Typical Low $562.34 Median $741.31 Typical High $933.25 | Professional | None | $562.34 | $741.31 | $933.25 |
BCBS North Carolina Setting Facility Modifier None Typical Low $1,380.38 Median $2,238.72 Typical High $5,495.41 | Facility | None | $1,380.38 | $2,238.72 | $5,495.41 |
BCBS North Carolina Setting Professional Modifier None Typical Low $588.84 Median $912.01 Typical High $1,380.38 | Professional | None | $588.84 | $912.01 | $1,380.38 |
Cigna Setting Facility Modifier None Typical Low $645.65 Median $2,187.76 Typical High $3,162.28 | Facility | None | $645.65 | $2,187.76 | $3,162.28 |
Cigna Setting Professional Modifier None Typical Low $436.52 Median $602.56 Typical High $1,348.96 | Professional | None | $436.52 | $602.56 | $1,348.96 |
Medcost Setting Facility Modifier None Typical Low $575.44 Median $977.24 Typical High $2,187.76 | Facility | None | $575.44 | $977.24 | $2,187.76 |
Medcost Setting Professional Modifier None Typical Low $549.54 Median $630.96 Typical High $912.01 | Professional | None | $549.54 | $630.96 | $912.01 |
United Setting Facility Modifier None Typical Low $851.14 Median $1,698.24 Typical High $8,709.64 | Facility | None | $851.14 | $1,698.24 | $8,709.64 |
United Setting Professional Modifier None Typical Low $416.87 Median $575.44 Typical High $1,230.27 | Professional | None | $416.87 | $575.44 | $1,230.27 |
10 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 $229.09 Median $251.19 Typical High $281.84 | Professional | 52 · Reduced service | $229.09 | $251.19 | $281.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $91.20 Median $100.00 Typical High $112.20 | Professional | 53 · Discontinued | $91.20 | $100.00 | $112.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $338.84 Median $371.54 Typical High $416.87 | Professional | 54 · Surgery only | $338.84 | $371.54 | $416.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $75.86 Typical High $83.18 | Professional | 55 · Aftercare only | $67.61 | $75.86 | $83.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $45.71 Median $50.12 Typical High $56.23 | Professional | 56 · Pre-op care only | $45.71 | $50.12 | $56.23 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $316.23 Median $346.74 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $316.23 | $346.74 | $389.05 |
Medcost Setting Facility Modifier 50 · Both sides Typical Low $891.25 Median $1,737.80 Typical High $4,265.80 | Facility | 50 · Both sides | $891.25 | $1,737.80 | $4,265.80 |
Medcost Setting Facility Modifier 51 · Multiple procedures Typical Low $295.12 Median $575.44 Typical High $1,412.54 | Facility | 51 · Multiple procedures | $295.12 | $575.44 | $1,412.54 |
Medcost Setting Professional Modifier 50 · Both sides Typical Low $831.76 Median $954.99 Typical High $2,344.23 | Professional | 50 · Both sides | $831.76 | $954.99 | $2,344.23 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $275.42 Median $316.23 Typical High $776.25 | Professional | 51 · Multiple procedures | $275.42 | $316.23 | $776.25 |
Where North Carolina sits
The same service costs 4.7 times more in Vermont than in Montana. 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 $7,643MT $1,633
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.