How much rates vary
Facilitymedian $1,413 · 10th to 90th $234 to $3,236Professionalmedian $282 · 10th to 90th $158 to $457
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 $169.82 Median $302.00 Typical High $794.33 | Facility | None | $169.82 | $302.00 | $794.33 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $34.67 Median $87.10 Typical High $158.49 | Facility | 53 · Discontinued | $34.67 | $87.10 | $158.49 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $302.00 Typical High $354.81 | Professional | None | $169.82 | $302.00 | $354.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $85.11 Typical High $158.49 | Professional | 53 · Discontinued | $34.67 | $85.11 | $158.49 |
Ambetter Setting Professional Modifier None Typical Low $158.49 Median $199.53 Typical High $263.03 | Professional | None | $158.49 | $199.53 | $263.03 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,000.00 Median $2,137.96 Typical High $3,890.45 | Facility | None | $1,000.00 | $2,137.96 | $3,890.45 |
Anthem BCBS Setting Professional Modifier None Typical Low $158.49 Median $251.19 Typical High $380.19 | Professional | None | $158.49 | $251.19 | $380.19 |
Anthem BCBS Setting Professional Modifier 53 · Discontinued Typical Low $77.62 Median $154.88 Typical High $245.47 | Professional | 53 · Discontinued | $77.62 | $154.88 | $245.47 |
CareSource Setting Facility Modifier None Typical Low $29.51 Median $194.98 Typical High $831.76 | Facility | None | $29.51 | $194.98 | $831.76 |
CareSource Setting Professional Modifier None Typical Low $38.02 Median $213.80 Typical High $363.08 | Professional | None | $38.02 | $213.80 | $363.08 |
Cigna Setting Facility Modifier None Typical Low $371.54 Median $489.78 Typical High $1,862.09 | Facility | None | $371.54 | $489.78 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $302.00 Typical High $1,819.70 | Professional | None | $218.78 | $302.00 | $1,819.70 |
Cigna Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $89.13 Typical High $173.78 | Professional | 53 · Discontinued | $41.69 | $89.13 | $173.78 |
Molina Setting Professional Modifier None Typical Low $33.11 Median $33.11 Typical High $117.49 | Professional | None | $33.11 | $33.11 | $117.49 |
United Setting Facility Modifier None Typical Low $323.59 Median $630.96 Typical High $1,995.26 | Facility | None | $323.59 | $630.96 | $1,995.26 |
United Setting Professional Modifier None Typical Low $199.53 Median $316.23 Typical High $537.03 | Professional | None | $199.53 | $316.23 | $537.03 |
United Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $89.13 Typical High $173.78 | Professional | 53 · Discontinued | $41.69 | $89.13 | $173.78 |
9 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 Facility Modifier 52 · Reduced service Typical Low $85.11 Median $151.36 Typical High $269.15 | Facility | 52 · Reduced service | $85.11 | $151.36 | $269.15 |
Aetna Setting Facility Modifier 54 · Surgery only Typical Low $125.89 Median $223.87 Typical High $398.11 | Facility | 54 · Surgery only | $125.89 | $223.87 | $398.11 |
Aetna Setting Facility Modifier 55 · Aftercare only Typical Low $25.12 Median $44.67 Typical High $79.43 | Facility | 55 · Aftercare only | $25.12 | $44.67 | $79.43 |
Aetna Setting Facility Modifier 56 · Pre-op care only Typical Low $16.98 Median $30.20 Typical High $53.70 | Facility | 56 · Pre-op care only | $16.98 | $30.20 | $53.70 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $85.11 Median $102.33 Typical High $165.96 | Professional | 52 · Reduced service | $85.11 | $102.33 | $165.96 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $125.89 Median $173.78 Typical High $251.19 | Professional | 54 · Surgery only | $125.89 | $173.78 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.12 Median $35.48 Typical High $50.12 | Professional | 55 · Aftercare only | $25.12 | $35.48 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $23.44 Typical High $33.11 | Professional | 56 · Pre-op care only | $16.98 | $23.44 | $33.11 |
Ambetter Setting Professional Modifier 52 · Reduced service Typical Low $66.07 Median $66.07 Typical High $66.07 | Professional | 52 · Reduced service | $66.07 | $66.07 | $66.07 |
Where Kentucky 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.