How much rates vary
Facilitymedian $3,020 · 10th to 90th $525 to $8,511Professionalmedian $417 · 10th to 90th $282 to $692
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 $323.59 Median $4,677.35 Typical High $10,232.93 | Facility | None | $323.59 | $4,677.35 | $10,232.93 |
Aetna Setting Professional Modifier None Typical Low $323.59 Median $457.09 Typical High $602.56 | Professional | None | $323.59 | $457.09 | $602.56 |
Cigna Setting Facility Modifier None Typical Low $1,174.90 Median $2,570.40 Typical High $3,801.89 | Facility | None | $1,174.90 | $2,570.40 | $3,801.89 |
Cigna Setting Professional Modifier None Typical Low $323.59 Median $467.74 Typical High $776.25 | Professional | None | $323.59 | $467.74 | $776.25 |
Emblem Health Setting Professional Modifier None Typical Low $588.84 Median $812.83 Typical High $812.83 | Professional | None | $588.84 | $812.83 | $812.83 |
Horizon BCBS Setting Facility Modifier None Typical Low $2,630.27 Median $4,677.35 Typical High $12,302.69 | Facility | None | $2,630.27 | $4,677.35 | $12,302.69 |
Horizon BCBS Setting Professional Modifier None Typical Low $309.03 Median $562.34 Typical High $933.25 | Professional | None | $309.03 | $562.34 | $933.25 |
United Setting Facility Modifier None Typical Low $1,122.02 Median $2,884.03 Typical High $6,760.83 | Facility | None | $1,122.02 | $2,884.03 | $6,760.83 |
United Setting Professional Modifier None Typical Low $245.47 Median $389.05 Typical High $602.56 | Professional | None | $245.47 | $389.05 | $602.56 |
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 $162.18 Median $204.17 Typical High $251.19 | Professional | 52 · Reduced service | $162.18 | $204.17 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $64.57 Median $83.18 Typical High $100.00 | Professional | 53 · Discontinued | $64.57 | $83.18 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $239.88 Median $309.03 Typical High $371.54 | Professional | 54 · Surgery only | $239.88 | $309.03 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $47.86 Median $61.66 Typical High $74.13 | Professional | 55 · Aftercare only | $47.86 | $61.66 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $32.36 Median $40.74 Typical High $50.12 | Professional | 56 · Pre-op care only | $32.36 | $40.74 | $50.12 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $223.87 Median $288.40 Typical High $346.74 | Professional | 78 · Unplanned return to OR | $223.87 | $288.40 | $346.74 |
Where New Jersey 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.