How much rates vary
Facilitymedian $1,738 · 10th to 90th $501 to $6,310Professionalmedian $447 · 10th to 90th $380 to $776
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 $407.38 Median $1,047.13 Typical High $7,585.78 | Facility | None | $407.38 | $1,047.13 | $7,585.78 |
Aetna Setting Professional Modifier None Typical Low $371.54 Median $426.58 Typical High $575.44 | Professional | None | $371.54 | $426.58 | $575.44 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $263.03 Median $288.40 Typical High $316.23 | Professional | 78 · Unplanned return to OR | $263.03 | $288.40 | $316.23 |
Ambetter Setting Professional Modifier None Typical Low $389.05 Median $660.69 Typical High $891.25 | Professional | None | $389.05 | $660.69 | $891.25 |
AmeriHealth Setting Facility Modifier None Typical Low $2,884.03 Median $3,715.35 Typical High $15,135.61 | Facility | None | $2,884.03 | $3,715.35 | $15,135.61 |
AmeriHealth Setting Professional Modifier None Typical Low $229.09 Median $457.09 Typical High $501.19 | Professional | None | $229.09 | $457.09 | $501.19 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $6,025.60 Typical High $8,709.64 | Facility | None | $3,981.07 | $6,025.60 | $8,709.64 |
Capital Blue Cross Setting Professional Modifier None Typical Low $446.68 Median $630.96 Typical High $891.25 | Professional | None | $446.68 | $630.96 | $891.25 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $338.84 Median $478.63 Typical High $691.83 | Professional | 78 · Unplanned return to OR | $338.84 | $478.63 | $691.83 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $933.25 Typical High $1,819.70 | Facility | None | $478.63 | $933.25 | $1,819.70 |
Cigna Setting Professional Modifier None Typical Low $389.05 Median $446.68 Typical High $776.25 | Professional | None | $389.05 | $446.68 | $776.25 |
Emblem Health Setting Professional Modifier None Typical Low $616.60 Median $831.76 Typical High $831.76 | Professional | None | $616.60 | $831.76 | $831.76 |
Geisinger Setting Facility Modifier None Typical Low $912.01 Median $1,148.15 Typical High $2,041.74 | Facility | None | $912.01 | $1,148.15 | $2,041.74 |
Geisinger Setting Professional Modifier None Typical Low $398.11 Median $588.84 Typical High $1,023.29 | Professional | None | $398.11 | $588.84 | $1,023.29 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,202.26 Median $3,235.94 Typical High $7,585.78 | Facility | None | $1,202.26 | $3,235.94 | $7,585.78 |
Highmark BCBS Setting Professional Modifier None Typical Low $436.52 Median $512.86 Typical High $758.58 | Professional | None | $436.52 | $512.86 | $758.58 |
Independence Blue Cross Setting Facility Modifier None Typical Low $2,238.72 Median $3,715.35 Typical High $9,772.37 | Facility | None | $2,238.72 | $3,715.35 | $9,772.37 |
Independence Blue Cross Setting Professional Modifier None Typical Low $229.09 Median $457.09 Typical High $501.19 | Professional | None | $229.09 | $457.09 | $501.19 |
Martin's Point Setting Facility Modifier None Typical Low $398.11 Median $1,513.56 Typical High $7,762.47 | Facility | None | $398.11 | $1,513.56 | $7,762.47 |
Martin's Point Setting Professional Modifier None Typical Low $371.54 Median $416.87 Typical High $562.34 | Professional | None | $371.54 | $416.87 | $562.34 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $263.03 Median $288.40 Typical High $316.23 | Professional | 78 · Unplanned return to OR | $263.03 | $288.40 | $316.23 |
Oscar Health Setting Facility Modifier None Typical Low $1,148.15 Median $4,786.30 Typical High $6,606.93 | Facility | None | $1,148.15 | $4,786.30 | $6,606.93 |
Oscar Health Setting Professional Modifier None Typical Low $467.74 Median $467.74 Typical High $812.83 | Professional | None | $467.74 | $467.74 | $812.83 |
UPMC Health Plan Setting Facility Modifier None Typical Low $398.11 Median $1,071.52 Typical High $2,511.89 | Facility | None | $398.11 | $1,071.52 | $2,511.89 |
UPMC Health Plan Setting Professional Modifier None Typical Low $398.11 Median $407.38 Typical High $436.52 | Professional | None | $398.11 | $407.38 | $436.52 |
United Setting Facility Modifier None Typical Low $812.83 Median $1,318.26 Typical High $4,365.16 | Facility | None | $812.83 | $1,318.26 | $4,365.16 |
United Setting Professional Modifier None Typical Low $416.87 Median $562.34 Typical High $707.95 | Professional | None | $416.87 | $562.34 | $707.95 |
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 Professional Modifier 52 · Reduced service Typical Low $186.21 Median $204.17 Typical High $229.09 | Professional | 52 · Reduced service | $186.21 | $204.17 | $229.09 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $74.13 Median $83.18 Typical High $91.20 | Professional | 53 · Discontinued | $74.13 | $83.18 | $91.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $281.84 Median $309.03 Typical High $338.84 | Professional | 54 · Surgery only | $281.84 | $309.03 | $338.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $56.23 Median $61.66 Typical High $67.61 | Professional | 55 · Aftercare only | $56.23 | $61.66 | $67.61 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $37.15 Median $41.69 Typical High $45.71 | Professional | 56 · Pre-op care only | $37.15 | $41.69 | $45.71 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $676.08 Median $954.99 Typical High $1,348.96 | Professional | 50 · Both sides | $676.08 | $954.99 | $1,348.96 |
Highmark BCBS Setting Professional Modifier 79 · Unrelated procedure after surgery Typical Low $436.52 Median $501.19 Typical High $562.34 | Professional | 79 · Unrelated procedure after surgery | $436.52 | $501.19 | $562.34 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $186.21 Median $204.17 Typical High $229.09 | Professional | 52 · Reduced service | $186.21 | $204.17 | $229.09 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $74.13 Median $81.28 Typical High $91.20 | Professional | 53 · Discontinued | $74.13 | $81.28 | $91.20 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $281.84 Median $309.03 Typical High $338.84 | Professional | 54 · Surgery only | $281.84 | $309.03 | $338.84 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $56.23 Median $61.66 Typical High $67.61 | Professional | 55 · Aftercare only | $56.23 | $61.66 | $67.61 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $37.15 Median $40.74 Typical High $45.71 | Professional | 56 · Pre-op care only | $37.15 | $40.74 | $45.71 |
Where Pennsylvania sits
The same service costs 4.1 times more in Vermont than in California. 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 $5,717CA $1,390
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.