How much rates vary
Facilitymedian $2,754 · 10th to 90th $977 to $8,913Professionalmedian $437 · 10th to 90th $309 to $2,399
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 $407.38 Median $4,265.80 Typical High $7,762.47 | Facility | None | $407.38 | $4,265.80 | $7,762.47 |
Aetna Setting Professional Modifier None Typical Low $269.15 Median $354.81 Typical High $537.03 | Professional | None | $269.15 | $354.81 | $537.03 |
Ambetter Setting Professional Modifier None Typical Low $251.19 Median $251.19 Typical High $251.19 | Professional | None | $251.19 | $251.19 | $251.19 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,318.26 Median $3,467.37 Typical High $7,079.46 | Facility | None | $1,318.26 | $3,467.37 | $7,079.46 |
Anthem BCBS Setting Professional Modifier None Typical Low $302.00 Median $371.54 Typical High $524.81 | Professional | None | $302.00 | $371.54 | $524.81 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $190.55 Median $234.42 Typical High $331.13 | Professional | 62 · Two surgeons | $190.55 | $234.42 | $331.13 |
BCBS Kansas City Setting Professional Modifier None Typical Low $316.23 Median $489.78 Typical High $602.56 | Professional | None | $316.23 | $489.78 | $602.56 |
Cigna Setting Facility Modifier None Typical Low $645.65 Median $2,089.30 Typical High $2,691.53 | Facility | None | $645.65 | $2,089.30 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $269.15 Median $457.09 Typical High $758.58 | Professional | None | $269.15 | $457.09 | $758.58 |
Medica Setting Facility Modifier None Typical Low $575.44 Median $2,344.23 Typical High $26,302.68 | Facility | None | $575.44 | $2,344.23 | $26,302.68 |
Medica Setting Professional Modifier None Typical Low $501.19 Median $2,398.83 Typical High $3,630.78 | Professional | None | $501.19 | $2,398.83 | $3,630.78 |
United Setting Facility Modifier None Typical Low $1,000.00 Median $2,818.38 Typical High $5,495.41 | Facility | None | $1,000.00 | $2,818.38 | $5,495.41 |
United Setting Professional Modifier None Typical Low $323.59 Median $489.78 Typical High $758.58 | Professional | None | $323.59 | $489.78 | $758.58 |
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 $134.90 Median $204.17 Typical High $251.19 | Professional | 52 · Reduced service | $134.90 | $204.17 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $54.95 Median $81.28 Typical High $100.00 | Professional | 53 · Discontinued | $54.95 | $81.28 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $204.17 Median $309.03 Typical High $380.19 | Professional | 54 · Surgery only | $204.17 | $309.03 | $380.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $40.74 Median $61.66 Typical High $75.86 | Professional | 55 · Aftercare only | $40.74 | $61.66 | $75.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.92 Median $40.74 Typical High $50.12 | Professional | 56 · Pre-op care only | $26.92 | $40.74 | $50.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $190.55 Median $288.40 Typical High $354.81 | Professional | 78 · Unplanned return to OR | $190.55 | $288.40 | $354.81 |
Where Missouri 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.