How much rates vary
Facilitymedian $2,512 · 10th to 90th $708 to $5,623Professionalmedian $1,318 · 10th to 90th $1,023 to $1,995
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 Professional Modifier None Typical Low $1,047.13 Median $1,230.27 Typical High $1,819.70 | Professional | None | $1,047.13 | $1,230.27 | $1,819.70 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,023.29 Median $1,348.96 Typical High $1,995.26 | Professional | None | $1,023.29 | $1,348.96 | $1,995.26 |
Anthem BCBS Setting Professional Modifier 62 · Two surgeons Typical Low $645.65 Median $851.14 Typical High $1,258.93 | Professional | 62 · Two surgeons | $645.65 | $851.14 | $1,258.93 |
Anthem BCBS Setting Professional Modifier 80 · Assistant surgeon Typical Low $162.18 Median $213.80 Typical High $323.59 | Professional | 80 · Assistant surgeon | $162.18 | $213.80 | $323.59 |
Anthem BCBS Setting Professional Modifier AS · PA/NP assist Typical Low $144.54 Median $186.21 Typical High $281.84 | Professional | AS · PA/NP assist | $144.54 | $186.21 | $281.84 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $2,454.71 Typical High $3,890.45 | Facility | None | $707.95 | $2,454.71 | $3,890.45 |
Cigna Setting Professional Modifier None Typical Low $1,174.90 Median $1,318.26 Typical High $1,995.26 | Professional | None | $1,174.90 | $1,318.26 | $1,995.26 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,023.29 Median $1,318.26 Typical High $1,819.70 | Professional | None | $1,023.29 | $1,318.26 | $1,819.70 |
Martin's Point Setting Professional Modifier None Typical Low $1,047.13 Median $1,230.27 Typical High $1,819.70 | Professional | None | $1,047.13 | $1,230.27 | $1,819.70 |
United Setting Facility Modifier None Typical Low $1,698.24 Median $2,511.89 Typical High $5,754.40 | Facility | None | $1,698.24 | $2,511.89 | $5,754.40 |
United Setting Professional Modifier None Typical Low $1,000.00 Median $1,318.26 Typical High $1,778.28 | Professional | None | $1,000.00 | $1,318.26 | $1,778.28 |
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 $537.03 Median $616.60 Typical High $616.60 | Professional | 52 · Reduced service | $537.03 | $616.60 | $616.60 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $218.78 Median $245.47 Typical High $245.47 | Professional | 53 · Discontinued | $218.78 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $812.83 Median $933.25 Typical High $933.25 | Professional | 54 · Surgery only | $812.83 | $933.25 | $933.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $162.18 Median $186.21 Typical High $186.21 | Professional | 55 · Aftercare only | $162.18 | $186.21 | $186.21 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $109.65 Median $123.03 Typical High $123.03 | Professional | 56 · Pre-op care only | $109.65 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $758.58 Median $870.96 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $758.58 | $870.96 | $870.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $602.56 Median $616.60 Typical High $616.60 | Professional | 52 · Reduced service | $602.56 | $616.60 | $616.60 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $239.88 Median $245.47 Typical High $245.47 | Professional | 53 · Discontinued | $239.88 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $891.25 Median $933.25 Typical High $933.25 | Professional | 54 · Surgery only | $891.25 | $933.25 | $933.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $181.97 Median $186.21 Typical High $186.21 | Professional | 55 · Aftercare only | $181.97 | $186.21 | $186.21 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $120.23 Median $123.03 Typical High $123.03 | Professional | 56 · Pre-op care only | $120.23 | $123.03 | $123.03 |
Martin's Point Setting Professional Modifier 78 · Unplanned return to OR Typical Low $831.76 Median $870.96 Typical High $870.96 | Professional | 78 · Unplanned return to OR | $831.76 | $870.96 | $870.96 |
Where Maine sits
The same service costs 5.3 times more in Vermont than in Hawaii. 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 $13,652HI $2,577
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.