How much rates vary
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 $257.04 Median $257.04 Typical High $257.04 | Professional | None | $257.04 | $257.04 | $257.04 |
Anthem BCBS Setting Professional Modifier None Typical Low $190.55 Median $275.42 Typical High $316.23 | Professional | None | $190.55 | $275.42 | $316.23 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $16,595.87 Typical High $22,387.21 | Facility | None | $707.95 | $16,595.87 | $22,387.21 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $263.03 Median $323.59 Typical High $489.78 | Professional | None | $263.03 | $323.59 | $489.78 |
Martin's Point Setting Professional Modifier None Typical Low $257.04 Median $257.04 Typical High $257.04 | Professional | None | $257.04 | $257.04 | $257.04 |
United Setting Facility Modifier None Typical Low $2,137.96 Median $2,691.53 Typical High $7,079.46 | Facility | None | $2,137.96 | $2,691.53 | $7,079.46 |
United Setting Professional Modifier None Typical Low $251.19 Median $323.59 Typical High $436.52 | Professional | None | $251.19 | $323.59 | $436.52 |
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 $125.89 Median $125.89 Typical High $125.89 | Professional | 52 · Reduced service | $125.89 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $51.29 Median $51.29 Typical High $51.29 | Professional | 53 · Discontinued | $51.29 | $51.29 | $51.29 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $190.55 Typical High $190.55 | Professional | 54 · Surgery only | $190.55 | $190.55 | $190.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | 55 · Aftercare only | $38.02 | $38.02 | $38.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | 56 · Pre-op care only | $25.70 | $25.70 | $25.70 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $125.89 Median $125.89 Typical High $125.89 | Professional | 52 · Reduced service | $125.89 | $125.89 | $125.89 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $51.29 Median $51.29 Typical High $51.29 | Professional | 53 · Discontinued | $51.29 | $51.29 | $51.29 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $190.55 Median $190.55 Typical High $190.55 | Professional | 54 · Surgery only | $190.55 | $190.55 | $190.55 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | 55 · Aftercare only | $38.02 | $38.02 | $38.02 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | 56 · Pre-op care only | $25.70 | $25.70 | $25.70 |
Where Maine sits
The same service costs 9.5 times more in Arkansas than in Kentucky. 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· 41st of 51
$275
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.