How much rates vary
Facilitymedian $457 · 10th to 90th $174 to $1,047Professionalmedian $309 · 10th to 90th $174 to $631
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 $173.78 Median $173.78 Typical High $309.03 | Facility | None | $173.78 | $173.78 | $309.03 |
Aetna Setting Professional Modifier None Typical Low $173.78 Median $309.03 Typical High $616.60 | Professional | None | $173.78 | $309.03 | $616.60 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $87.10 Typical High $288.40 | Professional | 53 · Discontinued | $34.67 | $87.10 | $288.40 |
Anthem BCBS Setting Professional Modifier None Typical Low $204.17 Median $346.74 Typical High $630.96 | Professional | None | $204.17 | $346.74 | $630.96 |
Anthem BCBS Setting Professional Modifier 53 · Discontinued Typical Low $91.20 Median $165.96 Typical High $316.23 | Professional | 53 · Discontinued | $91.20 | $165.96 | $316.23 |
Cigna Setting Facility Modifier None Typical Low $478.63 Median $512.86 Typical High $1,862.09 | Facility | None | $478.63 | $512.86 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $302.00 Median $302.00 Typical High $302.00 | Professional | None | $302.00 | $302.00 | $302.00 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $204.17 Median $338.84 Typical High $724.44 | Professional | None | $204.17 | $338.84 | $724.44 |
Martin's Point Setting Facility Modifier None Typical Low $173.78 Median $173.78 Typical High $309.03 | Facility | None | $173.78 | $173.78 | $309.03 |
Martin's Point Setting Professional Modifier None Typical Low $173.78 Median $309.03 Typical High $616.60 | Professional | None | $173.78 | $309.03 | $616.60 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $87.10 Typical High $288.40 | Professional | 53 · Discontinued | $34.67 | $87.10 | $288.40 |
United Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
United Setting Professional Modifier None Typical Low $190.55 Median $338.84 Typical High $630.96 | Professional | None | $190.55 | $338.84 | $630.96 |
8 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 $87.10 Median $102.33 Typical High $154.88 | Professional | 52 · Reduced service | $87.10 | $102.33 | $154.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $158.49 Typical High $234.42 | Professional | 54 · Surgery only | $131.83 | $158.49 | $234.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $31.62 Typical High $46.77 | Professional | 55 · Aftercare only | $26.30 | $31.62 | $46.77 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $21.38 Typical High $30.90 | Professional | 56 · Pre-op care only | $17.38 | $21.38 | $30.90 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $87.10 Median $102.33 Typical High $154.88 | Professional | 52 · Reduced service | $87.10 | $102.33 | $154.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $154.88 Typical High $234.42 | Professional | 54 · Surgery only | $131.83 | $154.88 | $234.42 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $30.90 Typical High $46.77 | Professional | 55 · Aftercare only | $26.30 | $30.90 | $46.77 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $20.89 Typical High $30.90 | Professional | 56 · Pre-op care only | $17.38 | $20.89 | $30.90 |
Where Maine 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.