How much rates vary
Professionalmedian $55 · 10th to 90th $50 to $79
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 Professional Modifier None (both parts) Typical Low $51.29 Median $51.29 Typical High $51.29 | Professional | None (both parts) | $51.29 | $51.29 | $51.29 |
Aetna Setting Professional Modifier 26 · Professional part Typical Low $19.50 Median $19.50 Typical High $19.50 | Professional | 26 · Professional part | $19.50 | $19.50 | $19.50 |
Aetna Setting Professional Modifier TC · Technical part Typical Low $31.62 Median $31.62 Typical High $31.62 | Professional | TC · Technical part | $31.62 | $31.62 | $31.62 |
Anthem BCBS Setting Professional Modifier None (both parts) Typical Low $44.67 Median $54.95 Typical High $61.66 | Professional | None (both parts) | $44.67 | $54.95 | $61.66 |
Anthem BCBS Setting Professional Modifier 26 · Professional part Typical Low $16.98 Median $19.95 Typical High $25.12 | Professional | 26 · Professional part | $16.98 | $19.95 | $25.12 |
Anthem BCBS Setting Professional Modifier TC · Technical part Typical Low $30.20 Median $35.48 Typical High $44.67 | Professional | TC · Technical part | $30.20 | $35.48 | $44.67 |
Harvard Pilgrim Setting Professional Modifier None (both parts) Typical Low $58.88 Median $69.18 Typical High $107.15 | Professional | None (both parts) | $58.88 | $69.18 | $107.15 |
Harvard Pilgrim Setting Professional Modifier 26 · Professional part Typical Low $25.70 Median $26.92 Typical High $41.69 | Professional | 26 · Professional part | $25.70 | $26.92 | $41.69 |
Harvard Pilgrim Setting Professional Modifier TC · Technical part Typical Low $38.90 Median $42.66 Typical High $66.07 | Professional | TC · Technical part | $38.90 | $42.66 | $66.07 |
Martin's Point Setting Professional Modifier None (both parts) Typical Low $51.29 Median $51.29 Typical High $51.29 | Professional | None (both parts) | $51.29 | $51.29 | $51.29 |
Martin's Point Setting Professional Modifier 26 · Professional part Typical Low $19.50 Median $19.50 Typical High $19.50 | Professional | 26 · Professional part | $19.50 | $19.50 | $19.50 |
Martin's Point Setting Professional Modifier TC · Technical part Typical Low $31.62 Median $31.62 Typical High $31.62 | Professional | TC · Technical part | $31.62 | $31.62 | $31.62 |
United Setting Professional Modifier None (both parts) Typical Low $48.98 Median $72.44 Typical High $109.65 | Professional | None (both parts) | $48.98 | $72.44 | $109.65 |
United Setting Professional Modifier 26 · Professional part Typical Low $19.95 Median $28.18 Typical High $40.74 | Professional | 26 · Professional part | $19.95 | $28.18 | $40.74 |
United Setting Professional Modifier TC · Technical part Typical Low $29.51 Median $43.65 Typical High $67.61 | Professional | TC · Technical part | $29.51 | $43.65 | $67.61 |
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 $25.70 Median $25.70 Typical High $25.70 | Professional | 52 · Reduced service | $25.70 | $25.70 | $25.70 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $10.23 Typical High $10.23 | Professional | 53 · Discontinued | $10.23 | $10.23 | $10.23 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | 54 · Surgery only | $38.02 | $38.02 | $38.02 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | 55 · Aftercare only | $7.59 | $7.59 | $7.59 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $5.13 Typical High $5.13 | Professional | 56 · Pre-op care only | $5.13 | $5.13 | $5.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | 52 · Reduced service | $25.70 | $25.70 | $25.70 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $10.23 Typical High $10.23 | Professional | 53 · Discontinued | $10.23 | $10.23 | $10.23 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | 54 · Surgery only | $38.02 | $38.02 | $38.02 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $7.59 Typical High $7.59 | Professional | 55 · Aftercare only | $7.59 | $7.59 | $7.59 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $5.13 Typical High $5.13 | Professional | 56 · Pre-op care only | $5.13 | $5.13 | $5.13 |
Where Maine sits
The same service costs 3.3 times more in Nebraska than in New York. 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.
Maine· 28th of 51
$54.95
NE $112NY $33.88
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.