How much rates vary
Facilitymedian $1,995 · 10th to 90th $741 to $2,399Professionalmedian $1,230 · 10th to 90th $724 to $2,512
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 $524.81 Median $933.25 Typical High $4,365.16 | Facility | None | $524.81 | $933.25 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $436.52 Median $660.69 Typical High $1,071.52 | Professional | None | $436.52 | $660.69 | $1,071.52 |
Cigna Setting Facility Modifier None Typical Low $1,318.26 Median $1,905.46 Typical High $2,290.87 | Facility | None | $1,318.26 | $1,905.46 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $1,023.29 Median $1,513.56 Typical High $2,344.23 | Professional | None | $1,023.29 | $1,513.56 | $2,344.23 |
Medica Setting Facility Modifier None Typical Low $741.31 Median $1,288.25 Typical High $2,398.83 | Facility | None | $741.31 | $1,288.25 | $2,398.83 |
Medica Setting Professional Modifier None Typical Low $794.33 Median $2,344.23 Typical High $6,606.93 | Professional | None | $794.33 | $2,344.23 | $6,606.93 |
Midlands Setting Professional Modifier None Typical Low $1,202.26 Median $1,202.26 Typical High $2,137.96 | Professional | None | $1,202.26 | $1,202.26 | $2,137.96 |
Midlands Setting Facility Modifier None Typical Low $1,096.48 Median $2,137.96 Typical High $2,290.87 | Facility | None | $1,096.48 | $2,137.96 | $2,290.87 |
Midlands Setting Professional Modifier None Typical Low $1,071.52 Median $1,174.90 Typical High $2,089.30 | Professional | None | $1,071.52 | $1,174.90 | $2,089.30 |
Sanford Health Plan Setting Professional Modifier None Typical Low $870.96 Median $1,122.02 Typical High $1,621.81 | Professional | None | $870.96 | $1,122.02 | $1,621.81 |
United Setting Facility Modifier None Typical Low $1,995.26 Median $1,995.26 Typical High $2,398.83 | Facility | None | $1,995.26 | $1,995.26 | $2,398.83 |
United Setting Professional Modifier None Typical Low $616.60 Median $1,380.38 Typical High $2,570.40 | Professional | None | $616.60 | $1,380.38 | $2,570.40 |
Wellmark Setting Professional Modifier None Typical Low $1,047.13 Median $1,230.27 Typical High $2,238.72 | Professional | None | $1,047.13 | $1,230.27 | $2,238.72 |
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 $218.78 Median $380.19 Typical High $446.68 | Professional | 52 · Reduced service | $218.78 | $380.19 | $446.68 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $89.13 Median $151.36 Typical High $177.83 | Professional | 53 · Discontinued | $89.13 | $151.36 | $177.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $331.13 Median $575.44 Typical High $676.08 | Professional | 54 · Surgery only | $331.13 | $575.44 | $676.08 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $114.82 Typical High $134.90 | Professional | 55 · Aftercare only | $66.07 | $114.82 | $134.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $75.86 Typical High $89.13 | Professional | 56 · Pre-op care only | $43.65 | $75.86 | $89.13 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $309.03 Median $537.03 Typical High $630.96 | Professional | 78 · Unplanned return to OR | $309.03 | $537.03 | $630.96 |
Where South Dakota sits
The same service costs 5.1 times more in Vermont than in West Virginia. 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 $8,943WV $1,744
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.