How much rates vary
Facilitymedian $1,698 · 10th to 90th $646 to $7,762Professionalmedian $347 · 10th to 90th $54 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 $851.14 Median $3,801.89 Typical High $10,964.78 | Facility | None | $851.14 | $3,801.89 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $263.03 Median $363.08 Typical High $912.01 | Professional | None | $263.03 | $363.08 | $912.01 |
Anthem BCBS Setting Facility Modifier None Typical Low $645.65 Median $1,698.24 Typical High $7,585.78 | Facility | None | $645.65 | $1,698.24 | $7,585.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $165.96 Median $194.98 Typical High $416.87 | Professional | None | $165.96 | $194.98 | $416.87 |
Aultcare Setting Professional Modifier None Typical Low $354.81 Median $354.81 Typical High $602.56 | Professional | None | $354.81 | $354.81 | $602.56 |
CareSource Setting Facility Modifier None Typical Low $398.11 Median $1,513.56 Typical High $1,995.26 | Facility | None | $398.11 | $1,513.56 | $1,995.26 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $1,737.80 Typical High $2,691.53 | Facility | None | $602.56 | $1,737.80 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $316.23 Median $478.63 Typical High $691.83 | Professional | None | $316.23 | $478.63 | $691.83 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $602.56 Median $1,737.80 Typical High $2,691.53 | Facility | None | $602.56 | $1,737.80 | $2,691.53 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $316.23 Median $478.63 Typical High $691.83 | Professional | None | $316.23 | $478.63 | $691.83 |
Molina Setting Professional Modifier None Typical Low $33.88 Median $316.23 Typical High $575.44 | Professional | None | $33.88 | $316.23 | $575.44 |
SummaCare Setting Facility Modifier None Typical Low $851.14 Median $891.25 Typical High $1,000.00 | Facility | None | $851.14 | $891.25 | $1,000.00 |
SummaCare Setting Professional Modifier None Typical Low $309.03 Median $407.38 Typical High $575.44 | Professional | None | $309.03 | $407.38 | $575.44 |
United Setting Facility Modifier None Typical Low $691.83 Median $1,445.44 Typical High $6,165.95 | Facility | None | $691.83 | $1,445.44 | $6,165.95 |
United Setting Professional Modifier None Typical Low $229.09 Median $380.19 Typical High $707.95 | Professional | None | $229.09 | $380.19 | $707.95 |
7 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 $154.88 Median $229.09 Typical High $239.88 | Professional | 52 · Reduced service | $154.88 | $229.09 | $239.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $61.66 Median $91.20 Typical High $95.50 | Professional | 53 · Discontinued | $61.66 | $91.20 | $95.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $234.42 Median $346.74 Typical High $363.08 | Professional | 54 · Surgery only | $234.42 | $346.74 | $363.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $46.77 Median $69.18 Typical High $72.44 | Professional | 55 · Aftercare only | $46.77 | $69.18 | $72.44 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $30.90 Median $45.71 Typical High $47.86 | Professional | 56 · Pre-op care only | $30.90 | $45.71 | $47.86 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $218.78 Median $323.59 Typical High $338.84 | Professional | 78 · Unplanned return to OR | $218.78 | $323.59 | $338.84 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $104.71 Median $123.03 Typical High $263.03 | Professional | 62 · Two surgeons | $104.71 | $123.03 | $263.03 |
Where Ohio 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.