How much rates vary
Facilitymedian $1,862 · 10th to 90th $617 to $8,511Professionalmedian $347 · 10th to 90th $240 to $562
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 $616.60 Median $4,168.69 Typical High $10,964.78 | Facility | None | $616.60 | $4,168.69 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $346.74 Median $436.52 Typical High $6,606.93 | Professional | None | $346.74 | $436.52 | $6,606.93 |
Ambetter Setting Professional Modifier None Typical Low $288.40 Median $371.54 Typical High $478.63 | Professional | None | $288.40 | $371.54 | $478.63 |
Anthem BCBS Setting Facility Modifier None Typical Low $630.96 Median $1,737.80 Typical High $7,585.78 | Facility | None | $630.96 | $1,737.80 | $7,585.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $269.15 Median $338.84 Typical High $549.54 | Professional | None | $269.15 | $338.84 | $549.54 |
CareSource Setting Facility Modifier None Typical Low $416.87 Median $1,621.81 Typical High $2,137.96 | Facility | None | $416.87 | $1,621.81 | $2,137.96 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $1,862.09 Typical High $2,818.38 | Facility | None | $602.56 | $1,862.09 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $302.00 Median $363.08 Typical High $691.83 | Professional | None | $302.00 | $363.08 | $691.83 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $602.56 Median $1,862.09 Typical High $3,162.28 | Facility | None | $602.56 | $1,862.09 | $3,162.28 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $302.00 Median $363.08 Typical High $707.95 | Professional | None | $302.00 | $363.08 | $707.95 |
Molina Setting Professional Modifier None Typical Low $47.86 Median $338.84 Typical High $467.74 | Professional | None | $47.86 | $338.84 | $467.74 |
SummaCare Setting Facility Modifier None Typical Low $891.25 Median $933.25 Typical High $1,071.52 | Facility | None | $891.25 | $933.25 | $1,071.52 |
SummaCare Setting Professional Modifier None Typical Low $323.59 Median $338.84 Typical High $478.63 | Professional | None | $323.59 | $338.84 | $478.63 |
United Setting Facility Modifier None Typical Low $707.95 Median $1,905.46 Typical High $7,413.10 | Facility | None | $707.95 | $1,905.46 | $7,413.10 |
United Setting Professional Modifier None Typical Low $302.00 Median $380.19 Typical High $776.25 | Professional | None | $302.00 | $380.19 | $776.25 |
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 $173.78 Median $173.78 Typical High $416.87 | Professional | 52 · Reduced service | $173.78 | $173.78 | $416.87 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $69.18 Median $69.18 Typical High $165.96 | Professional | 53 · Discontinued | $69.18 | $69.18 | $165.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $263.03 Median $263.03 Typical High $616.60 | Professional | 54 · Surgery only | $263.03 | $263.03 | $616.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $52.48 Median $52.48 Typical High $123.03 | Professional | 55 · Aftercare only | $52.48 | $52.48 | $123.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $34.67 Median $34.67 Typical High $83.18 | Professional | 56 · Pre-op care only | $34.67 | $34.67 | $83.18 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $245.47 Median $245.47 Typical High $575.44 | Professional | 78 · Unplanned return to OR | $245.47 | $245.47 | $575.44 |
Where Ohio 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.