How much rates vary
Facilitymedian $871 · 10th to 90th $398 to $3,311Professionalmedian $339 · 10th to 90th $170 to $631
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 $186.21 Median $338.84 Typical High $9,772.37 | Facility | None | $186.21 | $338.84 | $9,772.37 |
Aetna Setting Facility Modifier 53 · Discontinued Typical Low $67.61 Median $120.23 Typical High $213.80 | Facility | 53 · Discontinued | $67.61 | $120.23 | $213.80 |
Aetna Setting Professional Modifier None Typical Low $186.21 Median $302.00 Typical High $416.87 | Professional | None | $186.21 | $302.00 | $416.87 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $91.20 Typical High $169.82 | Professional | 53 · Discontinued | $37.15 | $91.20 | $169.82 |
Ambetter Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $288.40 | Professional | None | $158.49 | $158.49 | $288.40 |
BCBS South Carolina Setting Facility Modifier None Typical Low $645.65 Median $1,122.02 Typical High $3,019.95 | Facility | None | $645.65 | $1,122.02 | $3,019.95 |
BCBS South Carolina Setting Professional Modifier None Typical Low $158.49 Median $407.38 Typical High $776.25 | Professional | None | $158.49 | $407.38 | $776.25 |
BCBS South Carolina Setting Professional Modifier 53 · Discontinued Typical Low $79.43 Median $177.83 Typical High $177.83 | Professional | 53 · Discontinued | $79.43 | $177.83 | $177.83 |
Cigna Setting Facility Modifier None Typical Low $467.74 Median $489.78 Typical High $977.24 | Facility | None | $467.74 | $489.78 | $977.24 |
Cigna Setting Professional Modifier None Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | None | $302.00 | $302.00 | $302.00 |
Medcost Setting Professional Modifier None Typical Low $524.81 Median $562.34 Typical High $602.56 | Professional | None | $524.81 | $562.34 | $602.56 |
Medcost Setting Facility Modifier None Typical Low $194.98 Median $457.09 Typical High $851.14 | Facility | None | $194.98 | $457.09 | $851.14 |
Medcost Setting Professional Modifier None Typical Low $338.84 Median $363.08 Typical High $446.68 | Professional | None | $338.84 | $363.08 | $446.68 |
Molina Setting Professional Modifier None Typical Low $199.53 Median $346.74 Typical High $602.56 | Professional | None | $199.53 | $346.74 | $602.56 |
United Setting Facility Modifier None Typical Low $302.00 Median $1,122.02 Typical High $6,165.95 | Facility | None | $302.00 | $1,122.02 | $6,165.95 |
United Setting Professional Modifier None Typical Low $173.78 Median $309.03 Typical High $562.34 | Professional | None | $173.78 | $309.03 | $562.34 |
6 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 $93.33 Median $102.33 Typical High $169.82 | Professional | 52 · Reduced service | $93.33 | $102.33 | $169.82 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $138.04 Median $173.78 Typical High $257.04 | Professional | 54 · Surgery only | $138.04 | $173.78 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $35.48 Typical High $51.29 | Professional | 55 · Aftercare only | $27.54 | $35.48 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $23.44 Typical High $33.88 | Professional | 56 · Pre-op care only | $18.62 | $23.44 | $33.88 |
Ambetter Setting Professional Modifier KX · Policy requirements met Typical Low $288.40 Median $288.40 Typical High $288.40 | Professional | KX · Policy requirements met | $288.40 | $288.40 | $288.40 |
Medcost Setting Professional Modifier 51 · Multiple procedures Typical Low $169.82 Median $186.21 Typical High $302.00 | Professional | 51 · Multiple procedures | $169.82 | $186.21 | $302.00 |
Where South Carolina 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.