How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 Professional Modifier None Typical Low $117.49 Median $158.49 Typical High $177.83 | Professional | None | $117.49 | $158.49 | $177.83 |
Cigna Setting Facility Modifier None Typical Low $223.87 Median $223.87 Typical High $309.03 | Facility | None | $223.87 | $223.87 | $309.03 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $190.55 Typical High $218.78 | Professional | None | $158.49 | $190.55 | $218.78 |
MVP Health Care Setting Professional Modifier None Typical Low $151.36 Median $213.80 Typical High $380.19 | Professional | None | $151.36 | $213.80 | $380.19 |
United Setting Facility Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,258.93 | Facility | None | $1,258.93 | $1,258.93 | $1,258.93 |
United Setting Professional Modifier None Typical Low $134.90 Median $173.78 Typical High $257.04 | Professional | None | $134.90 | $173.78 | $257.04 |
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 $60.26 Median $79.43 Typical High $87.10 | Professional | 52 · Reduced service | $60.26 | $79.43 | $87.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $31.62 Typical High $35.48 | Professional | 53 · Discontinued | $23.99 | $31.62 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $117.49 Typical High $131.83 | Professional | 54 · Surgery only | $89.13 | $117.49 | $131.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $23.44 Typical High $26.30 | Professional | 55 · Aftercare only | $18.20 | $23.44 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $15.85 Typical High $17.78 | Professional | 56 · Pre-op care only | $12.02 | $15.85 | $17.78 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $83.18 Median $109.65 Typical High $123.03 | Professional | 78 · Unplanned return to OR | $83.18 | $109.65 | $123.03 |
Where Vermont sits
The same service costs 4.0 times more in Alaska than in New Jersey. 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.
Vermont· 22nd of 51
$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.