How much rates vary
Facilitymedian $3,311 · 10th to 90th $537 to $8,913Professionalmedian $407 · 10th to 90th $224 to $2,188
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 $275.42 Median $5,495.41 Typical High $9,332.54 | Facility | None | $275.42 | $5,495.41 | $9,332.54 |
Aetna Setting Professional Modifier None Typical Low $223.87 Median $323.59 Typical High $1,584.89 | Professional | None | $223.87 | $323.59 | $1,584.89 |
Ambetter Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | None | $173.78 | $173.78 | $173.78 |
AmeriHealth Setting Facility Modifier None Typical Low $2,570.40 Median $6,760.83 Typical High $12,302.69 | Facility | None | $2,570.40 | $6,760.83 | $12,302.69 |
AmeriHealth Setting Professional Modifier None Typical Low $229.09 Median $616.60 Typical High $2,951.21 | Professional | None | $229.09 | $616.60 | $2,951.21 |
Cigna Setting Facility Modifier None Typical Low $1,174.90 Median $2,691.53 Typical High $3,981.07 | Facility | None | $1,174.90 | $2,691.53 | $3,981.07 |
Cigna Setting Professional Modifier None Typical Low $199.53 Median $562.34 Typical High $2,137.96 | Professional | None | $199.53 | $562.34 | $2,137.96 |
Emblem Health Setting Professional Modifier None Typical Low $602.56 Median $2,137.96 Typical High $2,137.96 | Professional | None | $602.56 | $2,137.96 | $2,137.96 |
Horizon BCBS Setting Facility Modifier None Typical Low $2,570.40 Median $4,570.88 Typical High $12,302.69 | Facility | None | $2,570.40 | $4,570.88 | $12,302.69 |
Horizon BCBS Setting Professional Modifier None Typical Low $223.87 Median $1,513.56 Typical High $2,570.40 | Professional | None | $223.87 | $1,513.56 | $2,570.40 |
United Setting Facility Modifier None Typical Low $1,122.02 Median $2,754.23 Typical High $6,918.31 | Facility | None | $1,122.02 | $2,754.23 | $6,918.31 |
United Setting Professional Modifier None Typical Low $223.87 Median $562.34 Typical High $2,290.87 | Professional | None | $223.87 | $562.34 | $2,290.87 |
5 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 $131.83 Median $162.18 Typical High $251.19 | Professional | 52 · Reduced service | $131.83 | $162.18 | $251.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $53.70 Median $64.57 Typical High $100.00 | Professional | 53 · Discontinued | $53.70 | $64.57 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $199.53 Median $245.47 Typical High $380.19 | Professional | 54 · Surgery only | $199.53 | $245.47 | $380.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $39.81 Median $48.98 Typical High $75.86 | Professional | 55 · Aftercare only | $39.81 | $48.98 | $75.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.30 Median $32.36 Typical High $50.12 | Professional | 56 · Pre-op care only | $26.30 | $32.36 | $50.12 |
Where New Jersey 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.