How much rates vary
Facilitymedian $562 · 10th to 90th $324 to $955Professionalmedian $417 · 10th to 90th $209 to $933
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 $331.13 Typical High $4,365.16 | Facility | None | $186.21 | $331.13 | $4,365.16 |
Aetna Setting Professional Modifier None Typical Low $186.21 Median $331.13 Typical High $426.58 | Professional | None | $186.21 | $331.13 | $426.58 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $95.50 Typical High $190.55 | Professional | 53 · Discontinued | $38.02 | $95.50 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $575.44 Typical High $691.83 | Facility | None | $501.19 | $575.44 | $691.83 |
Cigna Setting Professional Modifier None Typical Low $194.98 Median $302.00 Typical High $501.19 | Professional | None | $194.98 | $302.00 | $501.19 |
Cigna Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $147.91 Typical High $251.19 | Professional | 53 · Discontinued | $147.91 | $147.91 | $251.19 |
Medica Setting Facility Modifier None Typical Low $323.59 Median $524.81 Typical High $758.58 | Facility | None | $323.59 | $524.81 | $758.58 |
Medica Setting Professional Modifier None Typical Low $295.12 Median $630.96 Typical High $2,187.76 | Professional | None | $295.12 | $630.96 | $2,187.76 |
Midlands Setting Professional Modifier None Typical Low $295.12 Median $389.05 Typical High $501.19 | Professional | None | $295.12 | $389.05 | $501.19 |
Midlands Setting Professional Modifier 53 · Discontinued Typical Low $147.91 Median $194.98 Typical High $251.19 | Professional | 53 · Discontinued | $147.91 | $194.98 | $251.19 |
Midlands Setting Facility Modifier None Typical Low $562.34 Median $691.83 Typical High $954.99 | Facility | None | $562.34 | $691.83 | $954.99 |
Midlands Setting Professional Modifier None Typical Low $389.05 Median $389.05 Typical High $676.08 | Professional | None | $389.05 | $389.05 | $676.08 |
Sanford Health Plan Setting Professional Modifier None Typical Low $263.03 Median $457.09 Typical High $630.96 | Professional | None | $263.03 | $457.09 | $630.96 |
United Setting Facility Modifier None Typical Low $446.68 Median $537.03 Typical High $758.58 | Facility | None | $446.68 | $537.03 | $758.58 |
United Setting Professional Modifier None Typical Low $234.42 Median $489.78 Typical High $933.25 | Professional | None | $234.42 | $489.78 | $933.25 |
Wellmark Setting Professional Modifier None Typical Low $363.08 Median $416.87 Typical High $977.24 | Professional | None | $363.08 | $416.87 | $977.24 |
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 $95.50 Median $102.33 Typical High $181.97 | Professional | 52 · Reduced service | $95.50 | $102.33 | $181.97 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $151.36 Typical High $275.42 | Professional | 54 · Surgery only | $144.54 | $151.36 | $275.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $30.20 Typical High $54.95 | Professional | 55 · Aftercare only | $28.84 | $30.20 | $54.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $20.42 Typical High $36.31 | Professional | 56 · Pre-op care only | $19.05 | $20.42 | $36.31 |
Where South Dakota 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.