How much rates vary
Facilitymedian $1,096 · 10th to 90th $372 to $5,623Professionalmedian $339 · 10th to 90th $200 to $1,175
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 $204.17 Median $2,511.89 Typical High $6,309.57 | Facility | None | $204.17 | $2,511.89 | $6,309.57 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $63.10 Median $131.83 Typical High $239.88 | Facility | 53 · Discontinued | $63.10 | $131.83 | $239.88 |
Aetna Setting Professional Modifier None Typical Low $169.82 Median $288.40 Typical High $380.19 | Professional | None | $169.82 | $288.40 | $380.19 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.88 Median $85.11 Typical High $169.82 | Professional | 53 · Discontinued | $33.88 | $85.11 | $169.82 |
Ambetter Setting Professional Modifier None Typical Low $158.49 Median $162.18 Typical High $501.19 | Professional | None | $158.49 | $162.18 | $501.19 |
Ambetter Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $125.89 Typical High $125.89 | Professional | 53 · Discontinued | $81.28 | $125.89 | $125.89 |
Anthem BCBS Setting Facility Modifier None Typical Low $630.96 Median $630.96 Typical High $630.96 | Facility | None | $630.96 | $630.96 | $630.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $208.93 Median $316.23 Typical High $524.81 | Professional | None | $208.93 | $316.23 | $524.81 |
BCBS Kansas City Setting Professional Modifier None Typical Low $173.78 Median $371.54 Typical High $501.19 | Professional | None | $173.78 | $371.54 | $501.19 |
BCBS Kansas City Setting Professional Modifier 53 · Discontinued Typical Low $85.11 Median $186.21 Typical High $251.19 | Professional | 53 · Discontinued | $85.11 | $186.21 | $251.19 |
Cigna Setting Facility Modifier None Typical Low $457.09 Median $501.19 Typical High $2,187.76 | Facility | None | $457.09 | $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 |
Medica Setting Facility Modifier None Typical Low $371.54 Median $1,096.48 Typical High $16,218.10 | Facility | None | $371.54 | $1,096.48 | $16,218.10 |
Medica Setting Professional Modifier None Typical Low $416.87 Median $1,174.90 Typical High $2,187.76 | Professional | None | $416.87 | $1,174.90 | $2,187.76 |
United Setting Facility Modifier None Typical Low $398.11 Median $1,148.15 Typical High $2,398.83 | Facility | None | $398.11 | $1,148.15 | $2,398.83 |
United Setting Professional Modifier None Typical Low $218.78 Median $363.08 Typical High $645.65 | Professional | None | $218.78 | $363.08 | $645.65 |
4 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 $85.11 Median $95.50 Typical High $169.82 | Professional | 52 · Reduced service | $85.11 | $95.50 | $169.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $125.89 Median $162.18 Typical High $257.04 | Professional | 54 · Surgery only | $125.89 | $162.18 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.12 Median $32.36 Typical High $51.29 | Professional | 55 · Aftercare only | $25.12 | $32.36 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.98 Median $21.38 Typical High $33.88 | Professional | 56 · Pre-op care only | $16.98 | $21.38 | $33.88 |
Where Missouri 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.