How much rates vary
Facilitymedian $3,467 · 10th to 90th $646 to $9,120Professionalmedian $589 · 10th to 90th $407 to $977
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 $436.52 Median $1,995.26 Typical High $7,943.28 | Facility | None | $436.52 | $1,995.26 | $7,943.28 |
Aetna Setting Professional Modifier None Typical Low $436.52 Median $630.96 Typical High $870.96 | Professional | None | $436.52 | $630.96 | $870.96 |
Ambetter Setting Professional Modifier None Typical Low $190.55 Median $398.11 Typical High $446.68 | Professional | None | $190.55 | $398.11 | $446.68 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,513.56 Median $4,466.84 Typical High $10,964.78 | Facility | None | $1,513.56 | $4,466.84 | $10,964.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $512.86 Median $602.56 Typical High $794.33 | Professional | None | $512.86 | $602.56 | $794.33 |
CDPHP Setting Facility Modifier None Typical Low $1,905.46 Median $2,951.21 Typical High $8,912.51 | Facility | None | $1,905.46 | $2,951.21 | $8,912.51 |
CDPHP Setting Professional Modifier None Typical Low $588.84 Median $588.84 Typical High $870.96 | Professional | None | $588.84 | $588.84 | $870.96 |
Cigna Setting Facility Modifier None Typical Low $1,318.26 Median $2,089.30 Typical High $4,265.80 | Facility | None | $1,318.26 | $2,089.30 | $4,265.80 |
Cigna Setting Professional Modifier None Typical Low $407.38 Median $588.84 Typical High $1,479.11 | Professional | None | $407.38 | $588.84 | $1,479.11 |
Emblem Health Setting Facility Modifier None Typical Low $363.08 Median $524.81 Typical High $1,621.81 | Facility | None | $363.08 | $524.81 | $1,621.81 |
Emblem Health Setting Professional Modifier None Typical Low $549.54 Median $758.58 Typical High $1,318.26 | Professional | None | $549.54 | $758.58 | $1,318.26 |
Excellus BCBS Setting Professional Modifier None Typical Low $338.84 Median $588.84 Typical High $776.25 | Professional | None | $338.84 | $588.84 | $776.25 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,174.90 Median $2,137.96 Typical High $6,165.95 | Facility | None | $1,174.90 | $2,137.96 | $6,165.95 |
Highmark BCBS Setting Professional Modifier None Typical Low $467.74 Median $602.56 Typical High $912.01 | Professional | None | $467.74 | $602.56 | $912.01 |
MVP Health Care Setting Facility Modifier None Typical Low $416.87 Median $3,235.94 Typical High $4,365.16 | Facility | None | $416.87 | $3,235.94 | $4,365.16 |
MVP Health Care Setting Professional Modifier None Typical Low $380.19 Median $380.19 Typical High $1,412.54 | Professional | None | $380.19 | $380.19 | $1,412.54 |
United Setting Facility Modifier None Typical Low $1,122.02 Median $2,398.83 Typical High $7,413.10 | Facility | None | $1,122.02 | $2,398.83 | $7,413.10 |
United Setting Professional Modifier None Typical Low $331.13 Median $537.03 Typical High $1,122.02 | Professional | None | $331.13 | $537.03 | $1,122.02 |
Univera Setting Facility Modifier None Typical Low $281.84 Median $549.54 Typical High $1,412.54 | Facility | None | $281.84 | $549.54 | $1,412.54 |
Univera Setting Professional Modifier None Typical Low $398.11 Median $549.54 Typical High $776.25 | Professional | None | $398.11 | $549.54 | $776.25 |
15 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 $218.78 Median $302.00 Typical High $316.23 | Professional | 52 · Reduced service | $218.78 | $302.00 | $316.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $87.10 Median $120.23 Typical High $125.89 | Professional | 53 · Discontinued | $87.10 | $120.23 | $125.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $323.59 Median $446.68 Typical High $478.63 | Professional | 54 · Surgery only | $323.59 | $446.68 | $478.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $64.57 Median $91.20 Typical High $95.50 | Professional | 55 · Aftercare only | $64.57 | $91.20 | $95.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $60.26 Typical High $63.10 | Professional | 56 · Pre-op care only | $43.65 | $60.26 | $63.10 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $302.00 Median $416.87 Typical High $446.68 | Professional | 78 · Unplanned return to OR | $302.00 | $416.87 | $446.68 |
Excellus BCBS Setting Professional Modifier 54 · Surgery only Typical Low $263.03 Median $457.09 Typical High $660.69 | Professional | 54 · Surgery only | $263.03 | $457.09 | $660.69 |
Excellus BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $123.03 Typical High $173.78 | Professional | 55 · Aftercare only | $70.79 | $123.03 | $173.78 |
Excellus BCBS Setting Professional Modifier 56 · Pre-op care only Typical Low $33.88 Median $58.88 Typical High $83.18 | Professional | 56 · Pre-op care only | $33.88 | $58.88 | $83.18 |
Excellus BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $234.42 Median $398.11 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $234.42 | $398.11 | $575.44 |
MVP Health Care Setting Professional Modifier 53 · Discontinued Typical Low $316.23 Median $323.59 Typical High $467.74 | Professional | 53 · Discontinued | $316.23 | $323.59 | $467.74 |
Univera Setting Professional Modifier 54 · Surgery only Typical Low $263.03 Median $478.63 Typical High $616.60 | Professional | 54 · Surgery only | $263.03 | $478.63 | $616.60 |
Univera Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $125.89 Typical High $288.40 | Professional | 55 · Aftercare only | $70.79 | $125.89 | $288.40 |
Univera Setting Professional Modifier 56 · Pre-op care only Typical Low $33.88 Median $60.26 Typical High $138.04 | Professional | 56 · Pre-op care only | $33.88 | $60.26 | $138.04 |
Univera Setting Professional Modifier 78 · Unplanned return to OR Typical Low $234.42 Median $416.87 Typical High $549.54 | Professional | 78 · Unplanned return to OR | $234.42 | $416.87 | $549.54 |
Where New York sits
The same service costs 6.2 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 $9,671MT $1,567
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.