How much rates vary
Facilitymedian $1,585 · 10th to 90th $589 to $5,370Professionalmedian $631 · 10th to 90th $240 to $2,291
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 $251.19 Median $4,073.80 Typical High $7,413.10 | Facility | None | $251.19 | $4,073.80 | $7,413.10 |
Aetna Setting Professional Modifier None Typical Low $186.21 Median $645.65 Typical High $2,570.40 | Professional | None | $186.21 | $645.65 | $2,570.40 |
Ambetter Setting Professional Modifier None Typical Low $223.87 Median $741.31 Typical High $2,454.71 | Professional | None | $223.87 | $741.31 | $2,454.71 |
Anthem BCBS Setting Facility Modifier None Typical Low $562.34 Median $1,071.52 Typical High $4,677.35 | Facility | None | $562.34 | $1,071.52 | $4,677.35 |
Anthem BCBS Setting Professional Modifier None Typical Low $239.88 Median $630.96 Typical High $2,290.87 | Professional | None | $239.88 | $630.96 | $2,290.87 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $190.55 Median $398.11 Typical High $1,445.44 | Professional | 62 · Two surgeons | $190.55 | $398.11 | $1,445.44 |
CareSource Setting Professional Modifier None Typical Low $1,445.44 Median $1,445.44 Typical High $1,548.82 | Professional | None | $1,445.44 | $1,445.44 | $1,548.82 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $2,041.74 Typical High $2,691.53 | Facility | None | $602.56 | $2,041.74 | $2,691.53 |
Cigna Setting Professional Modifier None Typical Low $239.88 Median $630.96 Typical High $2,884.03 | Professional | None | $239.88 | $630.96 | $2,884.03 |
Kaiser Permanente Setting Professional Modifier None Typical Low $229.09 Median $691.83 Typical High $1,698.24 | Professional | None | $229.09 | $691.83 | $1,698.24 |
Oscar Health Setting Facility Modifier None Typical Low $1,737.80 Median $8,912.51 Typical High $18,197.01 | Facility | None | $1,737.80 | $8,912.51 | $18,197.01 |
United Setting Facility Modifier None Typical Low $851.14 Median $1,513.56 Typical High $5,011.87 | Facility | None | $851.14 | $1,513.56 | $5,011.87 |
United Setting Professional Modifier None Typical Low $263.03 Median $501.19 Typical High $2,818.38 | Professional | None | $263.03 | $501.19 | $2,818.38 |
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 $93.33 Median $269.15 Typical High $724.44 | Professional | 52 · Reduced service | $93.33 | $269.15 | $724.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $107.15 Typical High $295.12 | Professional | 53 · Discontinued | $37.15 | $107.15 | $295.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $407.38 Typical High $1,096.48 | Professional | 54 · Surgery only | $141.25 | $407.38 | $1,096.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $81.28 Typical High $218.78 | Professional | 55 · Aftercare only | $28.18 | $81.28 | $218.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $53.70 Typical High $147.91 | Professional | 56 · Pre-op care only | $18.62 | $53.70 | $147.91 |
Ambetter Setting Professional Modifier 59 · Distinct service Typical Low $309.03 Median $389.05 Typical High $2,187.76 | Professional | 59 · Distinct service | $309.03 | $389.05 | $2,187.76 |
Where Georgia sits
The same service costs 4.3 times more in Vermont than in Maine. 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 $8,043ME $1,891
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.