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 $66.07 Median $79.43 Typical High $229.09 | Professional | None | $66.07 | $79.43 | $229.09 |
Anthem BCBS Setting Professional Modifier None Typical Low $69.18 Median $177.83 Typical High $446.68 | Professional | None | $69.18 | $177.83 | $446.68 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $707.95 Typical High $2,290.87 | Facility | None | $691.83 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $295.12 Typical High $512.86 | Professional | None | $104.71 | $295.12 | $512.86 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $83.18 Median $257.04 Typical High $467.74 | Professional | None | $83.18 | $257.04 | $467.74 |
Martin's Point Setting Professional Modifier None Typical Low $66.07 Median $79.43 Typical High $229.09 | Professional | None | $66.07 | $79.43 | $229.09 |
United Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
United Setting Professional Modifier None Typical Low $109.65 Median $218.78 Typical High $478.63 | Professional | None | $109.65 | $218.78 | $478.63 |
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 $33.11 Median $39.81 Typical High $114.82 | Professional | 52 · Reduced service | $33.11 | $39.81 | $114.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $15.85 Typical High $45.71 | Professional | 53 · Discontinued | $13.18 | $15.85 | $45.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $50.12 Median $60.26 Typical High $169.82 | Professional | 54 · Surgery only | $50.12 | $60.26 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $12.02 Typical High $33.88 | Professional | 55 · Aftercare only | $10.00 | $12.02 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $7.94 Typical High $22.91 | Professional | 56 · Pre-op care only | $6.61 | $7.94 | $22.91 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $33.11 Median $39.81 Typical High $114.82 | Professional | 52 · Reduced service | $33.11 | $39.81 | $114.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $15.85 Typical High $45.71 | Professional | 53 · Discontinued | $13.18 | $15.85 | $45.71 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $50.12 Median $60.26 Typical High $169.82 | Professional | 54 · Surgery only | $50.12 | $60.26 | $169.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $12.02 Typical High $33.88 | Professional | 55 · Aftercare only | $10.00 | $12.02 | $33.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $7.94 Typical High $22.91 | Professional | 56 · Pre-op care only | $6.61 | $7.94 | $22.91 |
Where Maine sits
The same service costs 4.5 times more in Oklahoma than in Nebraska. 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
$219
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.