How much rates vary
Facilitymedian $3,162 · 10th to 90th $550 to $9,333Professionalmedian $479 · 10th to 90th $331 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 $389.05 Median $5,128.61 Typical High $10,232.93 | Facility | None | $389.05 | $5,128.61 | $10,232.93 |
Aetna Setting Professional Modifier None Typical Low $331.13 Median $446.68 Typical High $954.99 | Professional | None | $331.13 | $446.68 | $954.99 |
AmeriHealth Setting Facility Modifier None Typical Low $3,162.28 Median $7,079.46 Typical High $11,748.98 | Facility | None | $3,162.28 | $7,079.46 | $11,748.98 |
AmeriHealth Setting Professional Modifier None Typical Low $407.38 Median $501.19 Typical High $851.14 | Professional | None | $407.38 | $501.19 | $851.14 |
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 $380.19 Median $489.78 Typical High $1,174.90 | Professional | None | $380.19 | $489.78 | $1,174.90 |
Emblem Health Setting Professional Modifier None Typical Low $707.95 Median $1,023.29 Typical High $1,023.29 | Professional | None | $707.95 | $1,023.29 | $1,023.29 |
Horizon BCBS Setting Facility Modifier None Typical Low $2,398.83 Median $4,073.80 Typical High $14,791.08 | Facility | None | $2,398.83 | $4,073.80 | $14,791.08 |
Horizon BCBS Setting Professional Modifier None Typical Low $446.68 Median $645.65 Typical High $1,584.89 | Professional | None | $446.68 | $645.65 | $1,584.89 |
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 $281.84 Median $446.68 Typical High $1,071.52 | Professional | None | $281.84 | $446.68 | $1,071.52 |
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 $165.96 Median $194.98 Typical High $239.88 | Professional | 52 · Reduced service | $165.96 | $194.98 | $239.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $66.07 Median $77.62 Typical High $95.50 | Professional | 53 · Discontinued | $66.07 | $77.62 | $95.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $251.19 Median $295.12 Typical High $363.08 | Professional | 54 · Surgery only | $251.19 | $295.12 | $363.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $50.12 Median $58.88 Typical High $72.44 | Professional | 55 · Aftercare only | $50.12 | $58.88 | $72.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $33.11 Median $38.90 Typical High $47.86 | Professional | 56 · Pre-op care only | $33.11 | $38.90 | $47.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $234.42 Median $275.42 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $234.42 | $275.42 | $338.84 |
Where New Jersey 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.