How much rates vary
Facilitymedian $851 · 10th to 90th $380 to $5,129Professionalmedian $263 · 10th to 90th $102 to $447
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 $162.18 Median $1,513.56 Typical High $9,120.11 | Facility | None | $162.18 | $1,513.56 | $9,120.11 |
Aetna Setting Professional Modifier None Typical Low $131.83 Median $269.15 Typical High $446.68 | Professional | None | $131.83 | $269.15 | $446.68 |
Ambetter Setting Professional Modifier None Typical Low $57.54 Median $120.23 Typical High $389.05 | Professional | None | $57.54 | $120.23 | $389.05 |
AvMed Setting Facility Modifier None Typical Low $354.81 Median $1,000.00 Typical High $9,549.93 | Facility | None | $354.81 | $1,000.00 | $9,549.93 |
AvMed Setting Professional Modifier None Typical Low $125.89 Median $323.59 Typical High $426.58 | Professional | None | $125.89 | $323.59 | $426.58 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $588.84 Typical High $2,187.76 | Facility | None | $426.58 | $588.84 | $2,187.76 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $257.04 Typical High $398.11 | Professional | None | $97.72 | $257.04 | $398.11 |
Florida Blue Setting Facility Modifier None Typical Low $363.08 Median $776.25 Typical High $4,570.88 | Facility | None | $363.08 | $776.25 | $4,570.88 |
Florida Blue Setting Professional Modifier None Typical Low $154.88 Median $288.40 Typical High $467.74 | Professional | None | $154.88 | $288.40 | $467.74 |
Molina Setting Professional Modifier None Typical Low $128.82 Median $331.13 Typical High $812.83 | Professional | None | $128.82 | $331.13 | $812.83 |
United Setting Facility Modifier None Typical Low $398.11 Median $1,000.00 Typical High $5,623.41 | Facility | None | $398.11 | $1,000.00 | $5,623.41 |
United Setting Professional Modifier None Typical Low $107.15 Median $251.19 Typical High $446.68 | Professional | None | $107.15 | $251.19 | $446.68 |
Wellpoint Setting Professional Modifier None Typical Low $95.50 Median $309.03 Typical High $309.03 | Professional | None | $95.50 | $309.03 | $309.03 |
12 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 $63.10 Median $134.90 Typical High $165.96 | Professional | 52 · Reduced service | $63.10 | $134.90 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $53.70 Typical High $66.07 | Professional | 53 · Discontinued | $25.12 | $53.70 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $95.50 Median $204.17 Typical High $245.47 | Professional | 54 · Surgery only | $95.50 | $204.17 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.05 Median $40.74 Typical High $48.98 | Professional | 55 · Aftercare only | $19.05 | $40.74 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $26.92 Typical High $33.11 | Professional | 56 · Pre-op care only | $12.59 | $26.92 | $33.11 |
Aetna Setting Professional Modifier 59 · Distinct service Typical Low $288.40 Median $354.81 Typical High $707.95 | Professional | 59 · Distinct service | $288.40 | $354.81 | $707.95 |
Ambetter Setting Professional Modifier 51 · Multiple procedures Typical Low $57.54 Median $57.54 Typical High $83.18 | Professional | 51 · Multiple procedures | $57.54 | $57.54 | $83.18 |
Ambetter Setting Professional Modifier 52 · Reduced service Typical Low $28.84 Median $28.84 Typical High $28.84 | Professional | 52 · Reduced service | $28.84 | $28.84 | $28.84 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $114.82 Median $371.54 Typical High $371.54 | Professional | 59 · Distinct service | $114.82 | $371.54 | $371.54 |
Ambetter Setting Professional Modifier PT · Screening turned treatment Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | PT · Screening turned treatment | $74.13 | $74.13 | $74.13 |
Ambetter Setting Professional Modifier XS · Separate structure Typical Low $60.26 Median $63.10 Typical High $204.17 | Professional | XS · Separate structure | $60.26 | $63.10 | $204.17 |
Ambetter Setting Professional Modifier XU · Unusual separate service Typical Low $45.71 Median $45.71 Typical High $45.71 | Professional | XU · Unusual separate service | $45.71 | $45.71 | $45.71 |
Where Florida sits
The same service costs 4.2 times more in Vermont than in Maryland. 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 $3,301MD $784
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.