How much rates vary
Facilitymedian $1,549 · 10th to 90th $407 to $5,754Professionalmedian $302 · 10th to 90th $123 to $407
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 $234.42 Median $3,388.44 Typical High $8,912.51 | Facility | None | $234.42 | $3,388.44 | $8,912.51 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $57.54 Median $75.86 Typical High $151.36 | Facility | 53 · Discontinued | $57.54 | $75.86 | $151.36 |
Aetna Setting Professional Modifier None Typical Low $204.17 Median $338.84 Typical High $426.58 | Professional | None | $204.17 | $338.84 | $426.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $75.86 Typical High $151.36 | Professional | 53 · Discontinued | $40.74 | $75.86 | $151.36 |
Ambetter Setting Professional Modifier None Typical Low $154.88 Median $162.18 Typical High $346.74 | Professional | None | $154.88 | $162.18 | $346.74 |
AmeriHealth Setting Facility Modifier None Typical Low $302.00 Median $426.58 Typical High $2,570.40 | Facility | None | $302.00 | $426.58 | $2,570.40 |
AmeriHealth Setting Professional Modifier None Typical Low $104.71 Median $151.36 Typical High $346.74 | Professional | None | $104.71 | $151.36 | $346.74 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $588.84 Typical High $2,238.72 | Facility | None | $537.03 | $588.84 | $2,238.72 |
Cigna Setting Professional Modifier None Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | None | $302.00 | $302.00 | $302.00 |
Emblem Health Setting Professional Modifier None Typical Low $446.68 Median $562.34 Typical High $831.76 | Professional | None | $446.68 | $562.34 | $831.76 |
Emblem Health Setting Professional Modifier 53 · Discontinued Typical Low $223.87 Median $281.84 Typical High $295.12 | Professional | 53 · Discontinued | $223.87 | $281.84 | $295.12 |
Horizon BCBS Setting Facility Modifier None Typical Low $758.58 Median $1,445.44 Typical High $3,467.37 | Facility | None | $758.58 | $1,445.44 | $3,467.37 |
Horizon BCBS Setting Professional Modifier None Typical Low $323.59 Median $380.19 Typical High $478.63 | Professional | None | $323.59 | $380.19 | $478.63 |
United Setting Facility Modifier None Typical Low $537.03 Median $1,548.82 Typical High $3,981.07 | Facility | None | $537.03 | $1,548.82 | $3,981.07 |
United Setting Professional Modifier None Typical Low $109.65 Median $239.88 Typical High $338.84 | Professional | None | $109.65 | $239.88 | $338.84 |
United Setting Professional Modifier 53 · Discontinued Typical Low $47.86 Median $79.43 Typical High $117.49 | Professional | 53 · Discontinued | $47.86 | $79.43 | $117.49 |
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 $102.33 Median $117.49 Typical High $199.53 | Professional | 52 · Reduced service | $102.33 | $117.49 | $199.53 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $151.36 Median $177.83 Typical High $295.12 | Professional | 54 · Surgery only | $151.36 | $177.83 | $295.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.20 Median $35.48 Typical High $60.26 | Professional | 55 · Aftercare only | $30.20 | $35.48 | $60.26 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $23.44 Typical High $39.81 | Professional | 56 · Pre-op care only | $20.42 | $23.44 | $39.81 |
Where New Jersey 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.