How much rates vary
Facilitymedian $1,905 · 10th to 90th $589 to $7,762Professionalmedian $575 · 10th to 90th $234 to $1,995
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 $371.54 Median $3,548.13 Typical High $10,964.78 | Facility | None | $371.54 | $3,548.13 | $10,964.78 |
Aetna Setting Professional Modifier None Typical Low $234.42 Median $1,318.26 Typical High $4,168.69 | Professional | None | $234.42 | $1,318.26 | $4,168.69 |
Ambetter Setting Professional Modifier None Typical Low $112.20 Median $234.42 Typical High $1,819.70 | Professional | None | $112.20 | $234.42 | $1,819.70 |
Anthem BCBS Setting Facility Modifier None Typical Low $562.34 Median $1,318.26 Typical High $4,786.30 | Facility | None | $562.34 | $1,318.26 | $4,786.30 |
Anthem BCBS Setting Professional Modifier None Typical Low $234.42 Median $275.42 Typical High $1,412.54 | Professional | None | $234.42 | $275.42 | $1,412.54 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $147.91 Median $173.78 Typical High $851.14 | Professional | 62 · Two surgeons | $147.91 | $173.78 | $851.14 |
CareSource Setting Facility Modifier None Typical Low $281.84 Median $1,621.81 Typical High $2,089.30 | Facility | None | $281.84 | $1,621.81 | $2,089.30 |
CareSource Setting Professional Modifier None Typical Low $1,348.96 Median $1,412.54 Typical High $1,513.56 | Professional | None | $1,348.96 | $1,412.54 | $1,513.56 |
Cigna Setting Facility Modifier None Typical Low $602.56 Median $1,819.70 Typical High $2,818.38 | Facility | None | $602.56 | $1,819.70 | $2,818.38 |
Cigna Setting Professional Modifier None Typical Low $234.42 Median $575.44 Typical High $1,737.80 | Professional | None | $234.42 | $575.44 | $1,737.80 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $630.96 Median $2,290.87 Typical High $6,025.60 | Facility | None | $630.96 | $2,290.87 | $6,025.60 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $234.42 Median $575.44 Typical High $1,778.28 | Professional | None | $234.42 | $575.44 | $1,778.28 |
Molina Setting Professional Modifier None Typical Low $1,148.15 Median $1,548.82 Typical High $2,089.30 | Professional | None | $1,148.15 | $1,548.82 | $2,089.30 |
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 $208.93 Median $549.54 Typical High $1,698.24 | Professional | None | $208.93 | $549.54 | $1,698.24 |
United Setting Facility Modifier None Typical Low $691.83 Median $1,445.44 Typical High $6,165.95 | Facility | None | $691.83 | $1,445.44 | $6,165.95 |
United Setting Professional Modifier None Typical Low $245.47 Median $380.19 Typical High $2,238.72 | Professional | None | $245.47 | $380.19 | $2,238.72 |
7 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 $117.49 Median $588.84 Typical High $691.83 | Professional | 52 · Reduced service | $117.49 | $588.84 | $691.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $239.88 Typical High $275.42 | Professional | 53 · Discontinued | $46.77 | $239.88 | $275.42 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $173.78 Median $891.25 Typical High $1,047.13 | Professional | 54 · Surgery only | $173.78 | $891.25 | $1,047.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $34.67 Median $177.83 Typical High $208.93 | Professional | 55 · Aftercare only | $34.67 | $177.83 | $208.93 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $117.49 Typical High $138.04 | Professional | 56 · Pre-op care only | $23.44 | $117.49 | $138.04 |
Ambetter Setting Professional Modifier 22 · Increased work Typical Low $91.20 Median $91.20 Typical High $91.20 | Professional | 22 · Increased work | $91.20 | $91.20 | $91.20 |
Ambetter Setting Professional Modifier GC · Resident with teaching physician Typical Low $181.97 Median $239.88 Typical High $263.03 | Professional | GC · Resident with teaching physician | $181.97 | $239.88 | $263.03 |
Where Ohio 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.