How much rates vary
Facilitymedian $1,698 · 10th to 90th $407 to $2,692Professionalmedian $501 · 10th to 90th $347 to $794
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 $407.38 Median $407.38 Typical High $616.60 | Facility | None | $407.38 | $407.38 | $616.60 |
Aetna Setting Professional Modifier None Typical Low $407.38 Median $512.86 Typical High $812.83 | Professional | None | $407.38 | $512.86 | $812.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $316.23 Median $436.52 Typical High $630.96 | Professional | None | $316.23 | $436.52 | $630.96 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $2,238.72 Typical High $2,951.21 | Facility | None | $812.83 | $2,238.72 | $2,951.21 |
Cigna Setting Professional Modifier None Typical Low $416.87 Median $616.60 Typical High $741.31 | Professional | None | $416.87 | $616.60 | $741.31 |
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 $354.81 Median $549.54 Typical High $954.99 | Professional | None | $354.81 | $549.54 | $954.99 |
Martin's Point Setting Professional Modifier None Typical Low $407.38 Median $562.34 Typical High $812.83 | Professional | None | $407.38 | $562.34 | $812.83 |
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 $316.23 Median $489.78 Typical High $794.33 | Professional | None | $316.23 | $489.78 | $794.33 |
13 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 $199.53 Median $199.53 Typical High $309.03 | Professional | 52 · Reduced service | $199.53 | $199.53 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $81.28 Typical High $123.03 | Professional | 53 · Discontinued | $81.28 | $81.28 | $123.03 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $302.00 Median $302.00 Typical High $467.74 | Professional | 54 · Surgery only | $302.00 | $302.00 | $467.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $60.26 Typical High $93.33 | Professional | 55 · Aftercare only | $60.26 | $60.26 | $93.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $40.74 Typical High $61.66 | Professional | 56 · Pre-op care only | $40.74 | $40.74 | $61.66 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $281.84 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $281.84 | $281.84 | $436.52 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $199.53 Median $275.42 Typical High $389.05 | Professional | 62 · Two surgeons | $199.53 | $275.42 | $389.05 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $199.53 Median $199.53 Typical High $309.03 | Professional | 52 · Reduced service | $199.53 | $199.53 | $309.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $81.28 Typical High $123.03 | Professional | 53 · Discontinued | $81.28 | $81.28 | $123.03 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $302.00 Median $302.00 Typical High $467.74 | Professional | 54 · Surgery only | $302.00 | $302.00 | $467.74 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $60.26 Typical High $93.33 | Professional | 55 · Aftercare only | $60.26 | $60.26 | $93.33 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $40.74 Typical High $61.66 | Professional | 56 · Pre-op care only | $40.74 | $40.74 | $61.66 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $281.84 Median $281.84 Typical High $436.52 | Professional | 78 · Unplanned return to OR | $281.84 | $281.84 | $436.52 |
Where Maine sits
The same service costs 11.0 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 $12,892MT $1,170
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.