How much rates vary
Facilitymedian $1,905 · 10th to 90th $398 to $7,244Professionalmedian $355 · 10th to 90th $214 to $603
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 $275.42 Median $398.11 Typical High $794.33 | Facility | None | $275.42 | $398.11 | $794.33 |
Aetna Setting Professional Modifier None Typical Low $275.42 Median $380.19 Typical High $562.34 | Professional | None | $275.42 | $380.19 | $562.34 |
Ambetter Setting Professional Modifier None Typical Low $457.09 Median $457.09 Typical High $457.09 | Professional | None | $457.09 | $457.09 | $457.09 |
Anthem BCBS Setting Facility Modifier None Typical Low $954.99 Median $2,884.03 Typical High $8,511.38 | Facility | None | $954.99 | $2,884.03 | $8,511.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $208.93 Median $257.04 Typical High $524.81 | Professional | None | $208.93 | $257.04 | $524.81 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $131.83 Median $158.49 Typical High $331.13 | Professional | 62 · Two surgeons | $131.83 | $158.49 | $331.13 |
CareSource Setting Facility Modifier None Typical Low $295.12 Median $478.63 Typical High $2,691.53 | Facility | None | $295.12 | $478.63 | $2,691.53 |
CareSource Setting Professional Modifier None Typical Low $269.15 Median $398.11 Typical High $489.78 | Professional | None | $269.15 | $398.11 | $489.78 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,862.09 Typical High $1,995.26 | Facility | None | $537.03 | $1,862.09 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $302.00 Median $446.68 Typical High $2,951.21 | Professional | None | $302.00 | $446.68 | $2,951.21 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $158.49 | Professional | None | $33.11 | $33.11 | $158.49 |
United Setting Facility Modifier None Typical Low $707.95 Median $1,174.90 Typical High $3,890.45 | Facility | None | $707.95 | $1,174.90 | $3,890.45 |
United Setting Professional Modifier None Typical Low $309.03 Median $436.52 Typical High $660.69 | Professional | None | $309.03 | $436.52 | $660.69 |
12 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 Facility Modifier 52 · Reduced service Typical Low $134.90 Median $194.98 Typical High $275.42 | Facility | 52 · Reduced service | $134.90 | $194.98 | $275.42 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $54.95 Median $79.43 Typical High $112.20 | Facility | 53 · Discontinued | $54.95 | $79.43 | $112.20 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $204.17 Median $295.12 Typical High $416.87 | Facility | 54 · Surgery only | $204.17 | $295.12 | $416.87 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $40.74 Median $58.88 Typical High $83.18 | Facility | 55 · Aftercare only | $40.74 | $58.88 | $83.18 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $27.54 Median $39.81 Typical High $56.23 | Facility | 56 · Pre-op care only | $27.54 | $39.81 | $56.23 |
Aetna Setting Facility Modifier 78 · Unplanned return to OR Typical Low $190.55 Median $275.42 Typical High $389.05 | Facility | 78 · Unplanned return to OR | $190.55 | $275.42 | $389.05 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $134.90 Median $194.98 Typical High $245.47 | Professional | 52 · Reduced service | $134.90 | $194.98 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $54.95 Median $79.43 Typical High $97.72 | Professional | 53 · Discontinued | $54.95 | $79.43 | $97.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $204.17 Median $295.12 Typical High $363.08 | Professional | 54 · Surgery only | $204.17 | $295.12 | $363.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $40.74 Median $58.88 Typical High $72.44 | Professional | 55 · Aftercare only | $40.74 | $58.88 | $72.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $27.54 Median $39.81 Typical High $48.98 | Professional | 56 · Pre-op care only | $27.54 | $39.81 | $48.98 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $190.55 Median $275.42 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $190.55 | $275.42 | $338.84 |
Where Kentucky 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.