How much rates vary
Facilitymedian $2,042 · 10th to 90th $759 to $7,244Professionalmedian $661 · 10th to 90th $447 to $1,023
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 $776.25 Median $1,174.90 Typical High $5,495.41 | Facility | None | $776.25 | $1,174.90 | $5,495.41 |
Aetna Setting Professional Modifier None Typical Low $407.38 Median $660.69 Typical High $977.24 | Professional | None | $407.38 | $660.69 | $977.24 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $489.78 Typical High $741.31 | Professional | 54 · Surgery only | $309.03 | $489.78 | $741.31 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $457.09 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $288.40 | $457.09 | $691.83 |
BCBS Setting Facility Modifier None Typical Low $1,737.80 Median $2,630.27 Typical High $8,511.38 | Facility | None | $1,737.80 | $2,630.27 | $8,511.38 |
BCBS Setting Professional Modifier None Typical Low $562.34 Median $741.31 Typical High $1,047.13 | Professional | None | $562.34 | $741.31 | $1,047.13 |
BCBS Setting Professional Modifier 54 · Surgery only Typical Low $501.19 Median $616.60 Typical High $891.25 | Professional | 54 · Surgery only | $501.19 | $616.60 | $891.25 |
BCBS Setting Professional Modifier 78 · Unplanned return to OR Typical Low $389.05 Median $478.63 Typical High $724.44 | Professional | 78 · Unplanned return to OR | $389.05 | $478.63 | $724.44 |
Cigna Setting Facility Modifier None Typical Low $1,819.70 Median $2,041.74 Typical High $2,754.23 | Facility | None | $1,819.70 | $2,041.74 | $2,754.23 |
Cigna Setting Professional Modifier None Typical Low $416.87 Median $537.03 Typical High $776.25 | Professional | None | $416.87 | $537.03 | $776.25 |
Moda Health Setting Facility Modifier None Typical Low $407.38 Median $933.25 Typical High $4,466.84 | Facility | None | $407.38 | $933.25 | $4,466.84 |
Moda Health Setting Professional Modifier None Typical Low $478.63 Median $776.25 Typical High $1,000.00 | Professional | None | $478.63 | $776.25 | $1,000.00 |
Moda Health Setting Professional Modifier 54 · Surgery only Typical Low $309.03 Median $489.78 Typical High $741.31 | Professional | 54 · Surgery only | $309.03 | $489.78 | $741.31 |
Moda Health Setting Professional Modifier 78 · Unplanned return to OR Typical Low $288.40 Median $457.09 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $288.40 | $457.09 | $691.83 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
MountainHealth Co-op Setting Facility Modifier None Typical Low $602.56 Median $602.56 Typical High $977.24 | Facility | None | $602.56 | $602.56 | $977.24 |
MountainHealth Co-op Setting Professional Modifier None Typical Low $602.56 Median $758.58 Typical High $1,230.27 | Professional | None | $602.56 | $758.58 | $1,230.27 |
MountainHealth Co-op Setting Professional Modifier 54 · Surgery only Typical Low $501.19 Median $501.19 Typical High $758.58 | Professional | 54 · Surgery only | $501.19 | $501.19 | $758.58 |
MountainHealth Co-op Setting Professional Modifier 78 · Unplanned return to OR Typical Low $537.03 Median $537.03 Typical High $812.83 | Professional | 78 · Unplanned return to OR | $537.03 | $537.03 | $812.83 |
Regence BlueShield Setting Facility Modifier None Typical Low $5,495.41 Median $7,762.47 Typical High $10,715.19 | Facility | None | $5,495.41 | $7,762.47 | $10,715.19 |
Regence BlueShield Setting Professional Modifier None Typical Low $645.65 Median $776.25 Typical High $1,174.90 | Professional | None | $645.65 | $776.25 | $1,174.90 |
Select Health Setting Facility Modifier None Typical Low $457.09 Median $467.74 Typical High $3,981.07 | Facility | None | $457.09 | $467.74 | $3,981.07 |
Select Health Setting Professional Modifier None Typical Low $331.13 Median $457.09 Typical High $1,862.09 | Professional | None | $331.13 | $457.09 | $1,862.09 |
United Setting Facility Modifier None Typical Low $1,047.13 Median $1,412.54 Typical High $1,621.81 | Facility | None | $1,047.13 | $1,412.54 | $1,621.81 |
United Setting Professional Modifier None Typical Low $346.74 Median $524.81 Typical High $870.96 | Professional | None | $346.74 | $524.81 | $870.96 |
13 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 $204.17 Median $331.13 Typical High $489.78 | Professional | 52 · Reduced service | $204.17 | $331.13 | $489.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $131.83 Typical High $199.53 | Professional | 53 · Discontinued | $81.28 | $131.83 | $199.53 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $97.72 Typical High $147.91 | Professional | 55 · Aftercare only | $61.66 | $97.72 | $147.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $66.07 Typical High $97.72 | Professional | 56 · Pre-op care only | $40.74 | $66.07 | $97.72 |
BCBS Setting Professional Modifier 55 · Aftercare only Typical Low $57.54 Median $87.10 Typical High $104.71 | Professional | 55 · Aftercare only | $57.54 | $87.10 | $104.71 |
BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $346.74 Median $426.58 Typical High $660.69 | Professional | 62 · Two surgeons | $346.74 | $426.58 | $660.69 |
BCBS Setting Professional Modifier 63 · Small infant Typical Low $676.08 Median $1,071.52 Typical High $1,288.25 | Professional | 63 · Small infant | $676.08 | $1,071.52 | $1,288.25 |
Moda Health Setting Professional Modifier 52 · Reduced service Typical Low $204.17 Median $331.13 Typical High $489.78 | Professional | 52 · Reduced service | $204.17 | $331.13 | $489.78 |
Moda Health Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $131.83 Typical High $199.53 | Professional | 53 · Discontinued | $81.28 | $131.83 | $199.53 |
Moda Health Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $97.72 Typical High $147.91 | Professional | 55 · Aftercare only | $61.66 | $97.72 | $147.91 |
Moda Health Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $66.07 Typical High $97.72 | Professional | 56 · Pre-op care only | $40.74 | $66.07 | $97.72 |
MountainHealth Co-op Setting Professional Modifier 56 · Pre-op care only Typical Low $72.44 Median $72.44 Typical High $107.15 | Professional | 56 · Pre-op care only | $72.44 | $72.44 | $107.15 |
MountainHealth Co-op Setting Professional Modifier 62 · Two surgeons Typical Low $446.68 Median $446.68 Typical High $676.08 | Professional | 62 · Two surgeons | $446.68 | $446.68 | $676.08 |
Where Idaho sits
The same service costs 11.0 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 $12,892MT $1,170
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.