How much rates vary
Facilitymedian $1,698 · 10th to 90th $363 to $4,169Professionalmedian $676 · 10th to 90th $398 to $1,096
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $363.08 Median $446.68 Typical High $61,659.50 | Facility | None | $363.08 | $446.68 | $61,659.50 |
Aetna Setting Professional Modifier None Typical Low $363.08 Median $446.68 Typical High $1,023.29 | Professional | None | $363.08 | $446.68 | $1,023.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $457.09 Median $660.69 Typical High $1,096.48 | Professional | None | $457.09 | $660.69 | $1,096.48 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $707.95 Median $1,000.00 Typical High $1,659.59 | Professional | 50 · Both sides | $707.95 | $1,000.00 | $1,659.59 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $302.00 Median $416.87 Typical High $691.83 | Professional | 62 · Two surgeons | $302.00 | $416.87 | $691.83 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $2,187.76 Typical High $2,884.03 | Facility | None | $812.83 | $2,187.76 | $2,884.03 |
Cigna Setting Professional Modifier None Typical Low $602.56 Median $831.76 Typical High $1,096.48 | Professional | None | $602.56 | $831.76 | $1,096.48 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $562.34 Median $794.33 Typical High $1,202.26 | Professional | None | $562.34 | $794.33 | $1,202.26 |
Martin's Point Setting Facility Modifier None Typical Low $61,659.50 Median $61,659.50 Typical High $89,125.09 | Facility | None | $61,659.50 | $61,659.50 | $89,125.09 |
Martin's Point Setting Professional Modifier None Typical Low $363.08 Median $446.68 Typical High $1,023.29 | Professional | None | $363.08 | $446.68 | $1,023.29 |
United Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
United Setting Professional Modifier None Typical Low $537.03 Median $758.58 Typical High $1,071.52 | Professional | None | $537.03 | $758.58 | $1,071.52 |
12 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 $181.97 Median $218.78 Typical High $218.78 | Professional | 52 · Reduced service | $181.97 | $218.78 | $218.78 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $72.44 Median $89.13 Typical High $89.13 | Professional | 53 · Discontinued | $72.44 | $89.13 | $89.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $275.42 Median $331.13 Typical High $331.13 | Professional | 54 · Surgery only | $275.42 | $331.13 | $331.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $54.95 Median $66.07 Typical High $66.07 | Professional | 55 · Aftercare only | $54.95 | $66.07 | $66.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $36.31 Median $44.67 Typical High $44.67 | Professional | 56 · Pre-op care only | $36.31 | $44.67 | $44.67 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $257.04 Median $309.03 Typical High $309.03 | Professional | 78 · Unplanned return to OR | $257.04 | $309.03 | $309.03 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $181.97 Median $218.78 Typical High $218.78 | Professional | 52 · Reduced service | $181.97 | $218.78 | $218.78 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $72.44 Median $89.13 Typical High $89.13 | Professional | 53 · Discontinued | $72.44 | $89.13 | $89.13 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $275.42 Median $331.13 Typical High $331.13 | Professional | 54 · Surgery only | $275.42 | $331.13 | $331.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $54.95 Median $66.07 Typical High $66.07 | Professional | 55 · Aftercare only | $54.95 | $66.07 | $66.07 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $36.31 Median $44.67 Typical High $44.67 | Professional | 56 · Pre-op care only | $36.31 | $44.67 | $44.67 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $257.04 Median $309.03 Typical High $309.03 | Professional | 78 · Unplanned return to OR | $257.04 | $309.03 | $309.03 |
Where Maine sits
The same service costs 4.7 times more in Vermont than in Montana. 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 $7,643MT $1,633
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.