How much rates vary
Facilitymedian $1,479 · 10th to 90th $347 to $6,310Professionalmedian $162 · 10th to 90th $83 to $457
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 $181.97 Median $4,466.84 Typical High $14,791.08 | Facility | None | $181.97 | $4,466.84 | $14,791.08 |
Aetna Setting Professional Modifier None Typical Low $87.10 Median $169.82 Typical High $331.13 | Professional | None | $87.10 | $169.82 | $331.13 |
Ambetter Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $257.04 | Professional | None | $257.04 | $257.04 | $257.04 |
Anthem BCBS Setting Facility Modifier None Typical Low $2,137.96 Median $4,786.30 Typical High $9,549.93 | Facility | None | $2,137.96 | $4,786.30 | $9,549.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $83.18 Median $162.18 Typical High $208.93 | Professional | None | $83.18 | $162.18 | $208.93 |
Blue Shield Setting Facility Modifier None Typical Low $100.00 Median $1,778.28 Typical High $4,897.79 | Facility | None | $100.00 | $1,778.28 | $4,897.79 |
Blue Shield Setting Professional Modifier None Typical Low $66.07 Median $109.65 Typical High $186.21 | Professional | None | $66.07 | $109.65 | $186.21 |
Central California Alliance for Health Setting Professional Modifier None Typical Low $107.15 Median $141.25 Typical High $398.11 | Professional | None | $107.15 | $141.25 | $398.11 |
Cigna Setting Facility Modifier None Typical Low $426.58 Median $831.76 Typical High $1,412.54 | Facility | None | $426.58 | $831.76 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $87.10 Median $162.18 Typical High $288.40 | Professional | None | $87.10 | $162.18 | $288.40 |
Contra Costa Health Setting Professional Modifier None Typical Low $79.43 Median $138.04 Typical High $389.05 | Professional | None | $79.43 | $138.04 | $389.05 |
Kaiser Permanente Setting Professional Modifier None Typical Low $107.15 Median $263.03 Typical High $436.52 | Professional | None | $107.15 | $263.03 | $436.52 |
Lucent Health Setting Professional Modifier None Typical Low $1,659.59 Median $2,344.23 Typical High $2,344.23 | Professional | None | $1,659.59 | $2,344.23 | $2,344.23 |
Molina Setting Professional Modifier None Typical Low $194.98 Median $194.98 Typical High $323.59 | Professional | None | $194.98 | $194.98 | $323.59 |
Optum Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $70.79 | Professional | None | $54.95 | $54.95 | $70.79 |
Providence Setting Facility Modifier None Typical Low $239.88 Median $831.76 Typical High $2,454.71 | Facility | None | $239.88 | $831.76 | $2,454.71 |
Providence Setting Professional Modifier None Typical Low $87.10 Median $162.18 Typical High $257.04 | Professional | None | $87.10 | $162.18 | $257.04 |
Sutter Health Plus Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $741.31 | Professional | None | $323.59 | $323.59 | $741.31 |
United Setting Facility Modifier None Typical Low $398.11 Median $1,230.27 Typical High $4,677.35 | Facility | None | $398.11 | $1,230.27 | $4,677.35 |
United Setting Professional Modifier None Typical Low $77.62 Median $169.82 Typical High $354.81 | Professional | None | $77.62 | $169.82 | $354.81 |
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 Facility Modifier 52 · Reduced service Typical Low $43.65 Median $50.12 Typical High $109.65 | Facility | 52 · Reduced service | $43.65 | $50.12 | $109.65 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $17.78 Median $20.42 Typical High $43.65 | Facility | 53 · Discontinued | $17.78 | $20.42 | $43.65 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $66.07 Median $75.86 Typical High $165.96 | Facility | 54 · Surgery only | $66.07 | $75.86 | $165.96 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $13.18 Median $15.14 Typical High $33.11 | Facility | 55 · Aftercare only | $13.18 | $15.14 | $33.11 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $8.71 Median $10.00 Typical High $21.88 | Facility | 56 · Pre-op care only | $8.71 | $10.00 | $21.88 |
Aetna Setting Facility Modifier 78 · Unplanned return to OR Typical Low $61.66 Median $70.79 Typical High $154.88 | Facility | 78 · Unplanned return to OR | $61.66 | $70.79 | $154.88 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $43.65 Median $79.43 Typical High $109.65 | Professional | 52 · Reduced service | $43.65 | $79.43 | $109.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $31.62 Typical High $43.65 | Professional | 53 · Discontinued | $17.38 | $31.62 | $43.65 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $64.57 Median $120.23 Typical High $165.96 | Professional | 54 · Surgery only | $64.57 | $120.23 | $165.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $23.99 Typical High $33.11 | Professional | 55 · Aftercare only | $12.88 | $23.99 | $33.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $15.85 Typical High $21.88 | Professional | 56 · Pre-op care only | $8.71 | $15.85 | $21.88 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $60.26 Median $112.20 Typical High $154.88 | Professional | 78 · Unplanned return to OR | $60.26 | $112.20 | $154.88 |
Where California sits
The same service costs 13.1 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 $5,338WV $408
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.