How much rates vary
Facilitymedian $8,128 · 10th to 90th $1,738 to $8,128Professionalmedian $1,230 · 10th to 90th $871 to $1,660
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 $794.33 Median $1,412.54 Typical High $2,630.27 | Facility | None | $794.33 | $1,412.54 | $2,630.27 |
Aetna Setting Professional Modifier None Typical Low $1,000.00 Median $1,659.59 Typical High $1,659.59 | Professional | None | $1,000.00 | $1,659.59 | $1,659.59 |
Ambetter Setting Professional Modifier None Typical Low $870.96 Median $870.96 Typical High $870.96 | Professional | None | $870.96 | $870.96 | $870.96 |
BCBS Alabama Setting Facility Modifier None Typical Low $8,128.31 Median $8,128.31 Typical High $8,128.31 | Facility | None | $8,128.31 | $8,128.31 | $8,128.31 |
BCBS Alabama Setting Professional Modifier 21 + 22 · Increased work + 24 · Unrelated visit after surgery Typical Low $1,122.02 Median $1,513.56 Typical High $1,698.24 | Professional | 21 + 22 · Increased work + 24 · Unrelated visit after surgery | $1,122.02 | $1,513.56 | $1,698.24 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $3,388.44 Typical High $4,365.16 | Facility | None | $549.54 | $3,388.44 | $4,365.16 |
Cigna Setting Professional Modifier None Typical Low $1,047.13 Median $1,230.27 Typical High $1,380.38 | Professional | None | $1,047.13 | $1,230.27 | $1,380.38 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $3,981.07 Typical High $8,511.38 | Facility | None | $1,698.24 | $3,981.07 | $8,511.38 |
United Setting Professional Modifier None Typical Low $812.83 Median $1,000.00 Typical High $1,659.59 | Professional | None | $812.83 | $1,000.00 | $1,659.59 |
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 $831.76 Median $831.76 Typical High $831.76 | Professional | 52 · Reduced service | $831.76 | $831.76 | $831.76 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $331.13 Median $331.13 Typical High $331.13 | Professional | 53 · Discontinued | $331.13 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,258.93 Median $1,258.93 Typical High $1,258.93 | Professional | 54 · Surgery only | $1,258.93 | $1,258.93 | $1,258.93 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $251.19 Median $251.19 Typical High $251.19 | Professional | 55 · Aftercare only | $251.19 | $251.19 | $251.19 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $165.96 Median $165.96 Typical High $165.96 | Professional | 56 · Pre-op care only | $165.96 | $165.96 | $165.96 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $1,174.90 Median $1,174.90 Typical High $1,174.90 | Professional | 78 · Unplanned return to OR | $1,174.90 | $1,174.90 | $1,174.90 |
BCBS Alabama Setting Facility Modifier 50 · Both sides Typical Low $12,302.69 Median $12,302.69 Typical High $12,302.69 | Facility | 50 · Both sides | $12,302.69 | $12,302.69 | $12,302.69 |
Where Alabama sits
The same service costs 6.2 times more in Vermont than in Hawaii. 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 $19,228HI $3,097
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.