How much rates vary
Facilitymedian $2,138 · 10th to 90th $347 to $9,550Professionalmedian $447 · 10th to 90th $219 to $1,175
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 $208.93 Median $616.60 Typical High $1,949.84 | Facility | None | $208.93 | $616.60 | $1,949.84 |
Aetna Setting Professional Modifier None Typical Low $208.93 Median $436.52 Typical High $1,479.11 | Professional | None | $208.93 | $436.52 | $1,479.11 |
Ambetter Setting Professional Modifier None Typical Low $275.42 Median $1,148.15 Typical High $1,148.15 | Professional | None | $275.42 | $1,148.15 | $1,148.15 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,202.26 Median $4,168.69 Typical High $10,715.19 | Facility | None | $1,202.26 | $4,168.69 | $10,715.19 |
Anthem BCBS Setting Professional Modifier None Typical Low $234.42 Median $446.68 Typical High $977.24 | Professional | None | $234.42 | $446.68 | $977.24 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $147.91 Median $275.42 Typical High $562.34 | Professional | 62 · Two surgeons | $147.91 | $275.42 | $562.34 |
CareSource Setting Facility Modifier None Typical Low $208.93 Median $302.00 Typical High $2,818.38 | Facility | None | $208.93 | $302.00 | $2,818.38 |
CareSource Setting Professional Modifier None Typical Low $269.15 Median $1,071.52 Typical High $1,513.56 | Professional | None | $269.15 | $1,071.52 | $1,513.56 |
Cigna Setting Facility Modifier None Typical Low $363.08 Median $1,862.09 Typical High $2,238.72 | Facility | None | $363.08 | $1,862.09 | $2,238.72 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $562.34 Typical High $6,165.95 | Professional | None | $218.78 | $562.34 | $6,165.95 |
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 $707.95 Median $1,288.25 Typical High $3,890.45 | Facility | None | $707.95 | $1,288.25 | $3,890.45 |
United Setting Professional Modifier None Typical Low $251.19 Median $416.87 Typical High $1,819.70 | Professional | None | $251.19 | $416.87 | $1,819.70 |
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 $104.71 Median $190.55 Typical High $588.84 | Facility | 52 · Reduced service | $104.71 | $190.55 | $588.84 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $41.69 Median $75.86 Typical High $234.42 | Facility | 53 · Discontinued | $41.69 | $75.86 | $234.42 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $154.88 Median $288.40 Typical High $870.96 | Facility | 54 · Surgery only | $154.88 | $288.40 | $870.96 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $30.90 Median $57.54 Typical High $177.83 | Facility | 55 · Aftercare only | $30.90 | $57.54 | $177.83 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $20.89 Median $38.02 Typical High $117.49 | Facility | 56 · Pre-op care only | $20.89 | $38.02 | $117.49 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $104.71 Median $190.55 Typical High $691.83 | Professional | 52 · Reduced service | $104.71 | $190.55 | $691.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $75.86 Typical High $275.42 | Professional | 53 · Discontinued | $41.69 | $75.86 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $288.40 Typical High $1,047.13 | Professional | 54 · Surgery only | $154.88 | $288.40 | $1,047.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $57.54 Typical High $208.93 | Professional | 55 · Aftercare only | $30.90 | $57.54 | $208.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.89 Median $38.02 Typical High $138.04 | Professional | 56 · Pre-op care only | $20.89 | $38.02 | $138.04 |
Ambetter Setting Professional Modifier 51 · Multiple procedures Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | 51 · Multiple procedures | $123.03 | $123.03 | $123.03 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $245.47 Median $245.47 Typical High $245.47 | Professional | GC · Resident with teaching physician | $245.47 | $245.47 | $245.47 |
Where Kentucky 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.