How much rates vary
Facilitymedian $1,413 · 10th to 90th $234 to $3,311Professionalmedian $479 · 10th to 90th $234 to $2,344
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 $1,412.54 Typical High $1,513.56 | Facility | None | $234.42 | $1,412.54 | $1,513.56 |
Aetna Setting Professional Modifier None Typical Low $234.42 Median $389.05 Typical High $2,041.74 | Professional | None | $234.42 | $389.05 | $2,041.74 |
Anthem BCBS Setting Professional Modifier None Typical Low $223.87 Median $912.01 Typical High $2,344.23 | Professional | None | $223.87 | $912.01 | $2,344.23 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $154.88 Median $575.44 Typical High $1,479.11 | Professional | 62 · Two surgeons | $154.88 | $575.44 | $1,479.11 |
Cigna Setting Facility Modifier None Typical Low $812.83 Median $2,290.87 Typical High $3,090.30 | Facility | None | $812.83 | $2,290.87 | $3,090.30 |
Cigna Setting Professional Modifier None Typical Low $316.23 Median $512.86 Typical High $2,398.83 | Professional | None | $316.23 | $512.86 | $2,398.83 |
Community Health Options Setting Facility Modifier None Typical Low $3,801.89 Median $3,801.89 Typical High $3,801.89 | Facility | None | $3,801.89 | $3,801.89 | $3,801.89 |
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 $263.03 Median $501.19 Typical High $2,398.83 | Professional | None | $263.03 | $501.19 | $2,398.83 |
Martin's Point Setting Facility Modifier None Typical Low $234.42 Median $1,412.54 Typical High $28,183.83 | Facility | None | $234.42 | $1,412.54 | $28,183.83 |
Martin's Point Setting Professional Modifier None Typical Low $234.42 Median $389.05 Typical High $2,041.74 | Professional | None | $234.42 | $389.05 | $2,041.74 |
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 $346.74 Median $478.63 Typical High $2,344.23 | Professional | None | $346.74 | $478.63 | $2,344.23 |
10 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 $117.49 Median $144.54 Typical High $707.95 | Professional | 52 · Reduced service | $117.49 | $144.54 | $707.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $57.54 Typical High $281.84 | Professional | 53 · Discontinued | $46.77 | $57.54 | $281.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $177.83 Median $218.78 Typical High $1,071.52 | Professional | 54 · Surgery only | $177.83 | $218.78 | $1,071.52 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $43.65 Typical High $213.80 | Professional | 55 · Aftercare only | $35.48 | $43.65 | $213.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $28.84 Typical High $141.25 | Professional | 56 · Pre-op care only | $23.44 | $28.84 | $141.25 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $117.49 Median $144.54 Typical High $707.95 | Professional | 52 · Reduced service | $117.49 | $144.54 | $707.95 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $57.54 Typical High $281.84 | Professional | 53 · Discontinued | $46.77 | $57.54 | $281.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $177.83 Median $218.78 Typical High $1,071.52 | Professional | 54 · Surgery only | $177.83 | $218.78 | $1,071.52 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $43.65 Typical High $213.80 | Professional | 55 · Aftercare only | $35.48 | $43.65 | $213.80 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $28.84 Typical High $141.25 | Professional | 56 · Pre-op care only | $23.44 | $28.84 | $141.25 |
Where Maine sits
The same service costs 4.3 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 $8,043ME $1,891
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.