How much rates vary
Facilitymedian $2,042 · 10th to 90th $407 to $8,128Professionalmedian $372 · 10th to 90th $295 to $575
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 $323.59 Median $323.59 Typical High $851.14 | Facility | None | $323.59 | $323.59 | $851.14 |
Aetna Setting Professional Modifier None Typical Low $323.59 Median $346.74 Typical High $489.78 | Professional | None | $323.59 | $346.74 | $489.78 |
Ambetter Setting Professional Modifier None Typical Low $501.19 Median $501.19 Typical High $501.19 | Professional | None | $501.19 | $501.19 | $501.19 |
Anthem BCBS Setting Facility Modifier None Typical Low $954.99 Median $2,884.03 Typical High $8,511.38 | Facility | None | $954.99 | $2,884.03 | $8,511.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $281.84 Median $363.08 Typical High $501.19 | Professional | None | $281.84 | $363.08 | $501.19 |
CareSource Setting Facility Modifier None Typical Low $309.03 Median $501.19 Typical High $2,818.38 | Facility | None | $309.03 | $501.19 | $2,818.38 |
CareSource Setting Professional Modifier None Typical Low $288.40 Median $436.52 Typical High $512.86 | Professional | None | $288.40 | $436.52 | $512.86 |
Cigna Setting Facility Modifier None Typical Low $549.54 Median $1,862.09 Typical High $2,089.30 | Facility | None | $549.54 | $1,862.09 | $2,089.30 |
Cigna Setting Professional Modifier None Typical Low $323.59 Median $501.19 Typical High $2,089.30 | Professional | None | $323.59 | $501.19 | $2,089.30 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $33.11 | Professional | None | $33.11 | $33.11 | $33.11 |
United Setting Facility Modifier None Typical Low $741.31 Median $1,479.11 Typical High $5,128.61 | Facility | None | $741.31 | $1,479.11 | $5,128.61 |
United Setting Professional Modifier None Typical Low $331.13 Median $436.52 Typical High $602.56 | Professional | None | $331.13 | $436.52 | $602.56 |
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 $162.18 Median $162.18 Typical High $204.17 | Professional | 52 · Reduced service | $162.18 | $162.18 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $64.57 Median $64.57 Typical High $81.28 | Professional | 53 · Discontinued | $64.57 | $64.57 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $245.47 Median $245.47 Typical High $302.00 | Professional | 54 · Surgery only | $245.47 | $245.47 | $302.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $48.98 Median $48.98 Typical High $60.26 | Professional | 55 · Aftercare only | $48.98 | $48.98 | $60.26 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $32.36 Median $32.36 Typical High $40.74 | Professional | 56 · Pre-op care only | $32.36 | $32.36 | $40.74 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $229.09 Median $229.09 Typical High $281.84 | Professional | 78 · Unplanned return to OR | $229.09 | $229.09 | $281.84 |
Where Kentucky sits
The same service costs 7.8 times more in Vermont than in Montana. 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 $8,433MT $1,087
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.