How much rates vary
Facilitymedian $955 · 10th to 90th $468 to $4,786Professionalmedian $309 · 10th to 90th $178 to $537
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 $316.23 Median $1,202.26 Typical High $10,715.19 | Facility | None | $316.23 | $1,202.26 | $10,715.19 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $281.84 Typical High $2,570.40 | Professional | None | $169.82 | $281.84 | $2,570.40 |
Ambetter Setting Professional Modifier None Typical Low $102.33 Median $102.33 Typical High $154.88 | Professional | None | $102.33 | $102.33 | $154.88 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $1,148.15 Typical High $4,466.84 | Facility | None | $524.81 | $1,148.15 | $4,466.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $181.97 Median $302.00 Typical High $512.86 | Professional | None | $181.97 | $302.00 | $512.86 |
CareSource Setting Facility Modifier None Typical Low $213.80 Median $758.58 Typical High $1,000.00 | Facility | None | $213.80 | $758.58 | $1,000.00 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $891.25 Typical High $1,995.26 | Facility | None | $489.78 | $891.25 | $1,995.26 |
Cigna Setting Professional Modifier None Typical Low $181.97 Median $281.84 Typical High $537.03 | Professional | None | $181.97 | $281.84 | $537.03 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $512.86 Median $891.25 Typical High $1,995.26 | Facility | None | $512.86 | $891.25 | $1,995.26 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $181.97 Median $281.84 Typical High $537.03 | Professional | None | $181.97 | $281.84 | $537.03 |
Molina Setting Professional Modifier None Typical Low $275.42 Median $363.08 Typical High $489.78 | Professional | None | $275.42 | $363.08 | $489.78 |
SummaCare Setting Facility Modifier None Typical Low $436.52 Median $457.09 Typical High $512.86 | Facility | None | $436.52 | $457.09 | $512.86 |
SummaCare Setting Professional Modifier None Typical Low $162.18 Median $323.59 Typical High $416.87 | Professional | None | $162.18 | $323.59 | $416.87 |
United Setting Facility Modifier None Typical Low $501.19 Median $977.24 Typical High $4,677.35 | Facility | None | $501.19 | $977.24 | $4,677.35 |
United Setting Professional Modifier None Typical Low $173.78 Median $302.00 Typical High $549.54 | Professional | None | $173.78 | $302.00 | $549.54 |
5 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 $85.11 Median $141.25 Typical High $144.54 | Professional | 52 · Reduced service | $85.11 | $141.25 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $56.23 Typical High $57.54 | Professional | 53 · Discontinued | $33.88 | $56.23 | $57.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $213.80 Typical High $213.80 | Professional | 54 · Surgery only | $128.82 | $213.80 | $213.80 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $42.66 Typical High $42.66 | Professional | 55 · Aftercare only | $25.70 | $42.66 | $42.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $28.18 Typical High $28.84 | Professional | 56 · Pre-op care only | $16.98 | $28.18 | $28.84 |
Where Ohio sits
The same service costs 7.0 times more in Vermont than in North Dakota. 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 $4,790ND $687
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.