How much rates vary
Facilitymedian $2,188 · 10th to 90th $813 to $6,457Professionalmedian $794 · 10th to 90th $646 to $1,000
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 $870.96 Median $4,786.30 Typical High $8,511.38 | Facility | None | $870.96 | $4,786.30 | $8,511.38 |
Aetna Setting Professional Modifier None Typical Low $741.31 Median $794.33 Typical High $891.25 | Professional | None | $741.31 | $794.33 | $891.25 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $549.54 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $549.54 | $549.54 | $616.60 |
Ambetter Setting Professional Modifier None Typical Low $676.08 Median $676.08 Typical High $676.08 | Professional | None | $676.08 | $676.08 | $676.08 |
Capital Blue Cross Setting Facility Modifier None Typical Low $3,981.07 Median $7,413.10 Typical High $56,234.13 | Facility | None | $3,981.07 | $7,413.10 | $56,234.13 |
Capital Blue Cross Setting Professional Modifier None Typical Low $794.33 Median $812.83 Typical High $1,230.27 | Professional | None | $794.33 | $812.83 | $1,230.27 |
Capital Blue Cross Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $575.44 Typical High $794.33 | Professional | 78 · Unplanned return to OR | $549.54 | $575.44 | $794.33 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $1,698.24 Typical High $2,884.03 | Facility | None | $616.60 | $1,698.24 | $2,884.03 |
Cigna Setting Professional Modifier None Typical Low $616.60 Median $707.95 Typical High $1,047.13 | Professional | None | $616.60 | $707.95 | $1,047.13 |
Emblem Health Setting Professional Modifier None Typical Low $851.14 Median $851.14 Typical High $1,174.90 | Professional | None | $851.14 | $851.14 | $1,174.90 |
Geisinger Setting Facility Modifier None Typical Low $1,698.24 Median $2,089.30 Typical High $3,715.35 | Facility | None | $1,698.24 | $2,089.30 | $3,715.35 |
Geisinger Setting Professional Modifier None Typical Low $660.69 Median $758.58 Typical High $1,318.26 | Professional | None | $660.69 | $758.58 | $1,318.26 |
Highmark BCBS Setting Facility Modifier None Typical Low $1,698.24 Median $3,162.28 Typical High $12,882.50 | Facility | None | $1,698.24 | $3,162.28 | $12,882.50 |
Highmark BCBS Setting Professional Modifier None Typical Low $851.14 Median $912.01 Typical High $1,023.29 | Professional | None | $851.14 | $912.01 | $1,023.29 |
Martin's Point Setting Facility Modifier None Typical Low $870.96 Median $4,570.88 Typical High $8,511.38 | Facility | None | $870.96 | $4,570.88 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $741.31 Median $794.33 Typical High $870.96 | Professional | None | $741.31 | $794.33 | $870.96 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $549.54 Median $549.54 Typical High $616.60 | Professional | 78 · Unplanned return to OR | $549.54 | $549.54 | $616.60 |
Oscar Health Setting Professional Modifier None Typical Low $776.25 Median $776.25 Typical High $831.76 | Professional | None | $776.25 | $776.25 | $831.76 |
UPMC Health Plan Setting Facility Modifier None Typical Low $758.58 Median $2,137.96 Typical High $4,265.80 | Facility | None | $758.58 | $2,137.96 | $4,265.80 |
UPMC Health Plan Setting Professional Modifier None Typical Low $758.58 Median $758.58 Typical High $776.25 | Professional | None | $758.58 | $758.58 | $776.25 |
United Setting Facility Modifier None Typical Low $1,148.15 Median $1,905.46 Typical High $6,025.60 | Facility | None | $1,148.15 | $1,905.46 | $6,025.60 |
United Setting Professional Modifier None Typical Low $630.96 Median $831.76 Typical High $1,230.27 | Professional | None | $630.96 | $831.76 | $1,230.27 |
11 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 $389.05 Median $398.11 Typical High $436.52 | Professional | 52 · Reduced service | $389.05 | $398.11 | $436.52 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $158.49 Typical High $177.83 | Professional | 53 · Discontinued | $154.88 | $158.49 | $177.83 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $588.84 Typical High $660.69 | Professional | 54 · Surgery only | $588.84 | $588.84 | $660.69 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $117.49 Median $117.49 Typical High $131.83 | Professional | 55 · Aftercare only | $117.49 | $117.49 | $131.83 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $77.62 Median $79.43 Typical High $87.10 | Professional | 56 · Pre-op care only | $77.62 | $79.43 | $87.10 |
Capital Blue Cross Setting Professional Modifier 50 · Both sides Typical Low $1,174.90 Median $1,230.27 Typical High $1,698.24 | Professional | 50 · Both sides | $1,174.90 | $1,230.27 | $1,698.24 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $389.05 Median $398.11 Typical High $436.52 | Professional | 52 · Reduced service | $389.05 | $398.11 | $436.52 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $154.88 Median $158.49 Typical High $177.83 | Professional | 53 · Discontinued | $154.88 | $158.49 | $177.83 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $588.84 Median $588.84 Typical High $660.69 | Professional | 54 · Surgery only | $588.84 | $588.84 | $660.69 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $117.49 Median $117.49 Typical High $131.83 | Professional | 55 · Aftercare only | $117.49 | $117.49 | $131.83 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $77.62 Median $79.43 Typical High $87.10 | Professional | 56 · Pre-op care only | $77.62 | $79.43 | $87.10 |
Where Pennsylvania sits
The same service costs 3.6 times more in Vermont than in Montana. 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 $8,561MT $2,405
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.