How much rates vary
Facilitymedian $1,514 · 10th to 90th $617 to $2,042Professionalmedian $1,047 · 10th to 90th $479 to $1,514
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 $446.68 Median $549.54 Typical High $4,365.16 | Facility | None | $446.68 | $549.54 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $380.19 Median $478.63 Typical High $741.31 | Professional | None | $380.19 | $478.63 | $741.31 |
Cigna Setting Facility Modifier None Typical Low $831.76 Median $1,584.89 Typical High $2,041.74 | Facility | None | $831.76 | $1,584.89 | $2,041.74 |
Cigna Setting Professional Modifier None Typical Low $933.25 Median $1,230.27 Typical High $1,621.81 | Professional | None | $933.25 | $1,230.27 | $1,621.81 |
Medica Setting Facility Modifier None Typical Low $588.84 Median $812.83 Typical High $1,698.24 | Facility | None | $588.84 | $812.83 | $1,698.24 |
Medica Setting Professional Modifier None Typical Low $489.78 Median $1,445.44 Typical High $4,168.69 | Professional | None | $489.78 | $1,445.44 | $4,168.69 |
Midlands Setting Professional Modifier None Typical Low $1,023.29 Median $1,047.13 Typical High $1,230.27 | Professional | None | $1,023.29 | $1,047.13 | $1,230.27 |
Midlands Setting Facility Modifier None Typical Low $1,096.48 Median $1,737.80 Typical High $2,187.76 | Facility | None | $1,096.48 | $1,737.80 | $2,187.76 |
Midlands Setting Professional Modifier None Typical Low $954.99 Median $954.99 Typical High $1,122.02 | Professional | None | $954.99 | $954.99 | $1,122.02 |
Sanford Health Plan Setting Professional Modifier None Typical Low $588.84 Median $870.96 Typical High $1,096.48 | Professional | None | $588.84 | $870.96 | $1,096.48 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $1,513.56 Typical High $1,819.70 | Facility | None | $1,513.56 | $1,513.56 | $1,819.70 |
United Setting Professional Modifier None Typical Low $478.63 Median $1,202.26 Typical High $1,513.56 | Professional | None | $478.63 | $1,202.26 | $1,513.56 |
Wellmark Setting Professional Modifier None Typical Low $851.14 Median $1,047.13 Typical High $1,445.44 | Professional | None | $851.14 | $1,047.13 | $1,445.44 |
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 $190.55 Median $223.87 Typical High $275.42 | Professional | 52 · Reduced service | $190.55 | $223.87 | $275.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $75.86 Median $91.20 Typical High $109.65 | Professional | 53 · Discontinued | $75.86 | $91.20 | $109.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $281.84 Median $338.84 Typical High $416.87 | Professional | 54 · Surgery only | $281.84 | $338.84 | $416.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $57.54 Median $67.61 Typical High $83.18 | Professional | 55 · Aftercare only | $57.54 | $67.61 | $83.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $38.02 Median $44.67 Typical High $54.95 | Professional | 56 · Pre-op care only | $38.02 | $44.67 | $54.95 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $263.03 Median $316.23 Typical High $389.05 | Professional | 78 · Unplanned return to OR | $263.03 | $316.23 | $389.05 |
Where South Dakota 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.