How much rates vary
Facilitymedian $646 · 10th to 90th $316 to $2,570Professionalmedian $282 · 10th to 90th $155 to $417
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 $213.80 Median $2,344.23 Typical High $10,715.19 | Facility | None | $213.80 | $2,344.23 | $10,715.19 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $38.90 Median $72.44 Typical High $147.91 | Facility | 53 · Discontinued | $38.90 | $72.44 | $147.91 |
Aetna Setting Professional Modifier None Typical Low $151.36 Median $239.88 Typical High $398.11 | Professional | None | $151.36 | $239.88 | $398.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $69.18 Typical High $158.49 | Professional | 53 · Discontinued | $35.48 | $69.18 | $158.49 |
Ambetter Setting Professional Modifier None Typical Low $169.82 Median $177.83 Typical High $407.38 | Professional | None | $169.82 | $177.83 | $407.38 |
Ambetter Setting Professional Modifier 53 · Discontinued Typical Low $85.11 Median $85.11 Typical High $186.21 | Professional | 53 · Discontinued | $85.11 | $85.11 | $186.21 |
AvMed Setting Facility Modifier None Typical Low $151.36 Median $489.78 Typical High $1,318.26 | Facility | None | $151.36 | $489.78 | $1,318.26 |
AvMed Setting Professional Modifier None Typical Low $85.11 Median $165.96 Typical High $363.08 | Professional | None | $85.11 | $165.96 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $436.52 Median $501.19 Typical High $2,187.76 | Facility | None | $436.52 | $501.19 | $2,187.76 |
Cigna Setting Professional Modifier None Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | None | $302.00 | $302.00 | $302.00 |
Florida Blue Setting Facility Modifier None Typical Low $338.84 Median $707.95 Typical High $1,905.46 | Facility | None | $338.84 | $707.95 | $1,905.46 |
Florida Blue Setting Facility Modifier 53 · Discontinued Typical Low $870.96 Median $891.25 Typical High $891.25 | Facility | 53 · Discontinued | $870.96 | $891.25 | $891.25 |
Florida Blue Setting Professional Modifier None Typical Low $177.83 Median $371.54 Typical High $436.52 | Professional | None | $177.83 | $371.54 | $436.52 |
Florida Blue Setting Professional Modifier 53 · Discontinued Typical Low $60.26 Median $123.03 Typical High $213.80 | Professional | 53 · Discontinued | $60.26 | $123.03 | $213.80 |
Molina Setting Professional Modifier None Typical Low $154.88 Median $281.84 Typical High $616.60 | Professional | None | $154.88 | $281.84 | $616.60 |
United Setting Facility Modifier None Typical Low $281.84 Median $660.69 Typical High $3,981.07 | Facility | None | $281.84 | $660.69 | $3,981.07 |
United Setting Professional Modifier None Typical Low $144.54 Median $239.88 Typical High $416.87 | Professional | None | $144.54 | $239.88 | $416.87 |
Wellpoint Setting Professional Modifier None Typical Low $165.96 Median $371.54 Typical High $380.19 | Professional | None | $165.96 | $371.54 | $380.19 |
Wellpoint Setting Professional Modifier 53 · Discontinued Typical Low $83.18 Median $186.21 Typical High $190.55 | Professional | 53 · Discontinued | $83.18 | $186.21 | $190.55 |
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 $74.13 Median $104.71 Typical High $158.49 | Professional | 52 · Reduced service | $74.13 | $104.71 | $158.49 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $112.20 Median $158.49 Typical High $239.88 | Professional | 54 · Surgery only | $112.20 | $158.49 | $239.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $31.62 Typical High $47.86 | Professional | 55 · Aftercare only | $22.39 | $31.62 | $47.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.79 Median $21.38 Typical High $31.62 | Professional | 56 · Pre-op care only | $14.79 | $21.38 | $31.62 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $169.82 Median $169.82 Typical High $371.54 | Professional | KX · Policy requirements met | $169.82 | $169.82 | $371.54 |
Where Florida sits
The same service costs 5.8 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 $4,478ME $766
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.