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 $44.67 Median $79.43 Typical High $165.96 | Professional | None | $44.67 | $79.43 | $165.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $51.29 Median $102.33 Typical High $190.55 | Professional | None | $51.29 | $102.33 | $190.55 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $102.33 Typical High $707.95 | Facility | None | $56.23 | $102.33 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $125.89 Typical High $194.98 | Professional | None | $79.43 | $125.89 | $194.98 |
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 $66.07 Median $123.03 Typical High $194.98 | Professional | None | $66.07 | $123.03 | $194.98 |
Martin's Point Setting Professional Modifier None Typical Low $44.67 Median $79.43 Typical High $165.96 | Professional | None | $44.67 | $79.43 | $165.96 |
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 $87.10 Median $123.03 Typical High $204.17 | Professional | None | $87.10 | $123.03 | $204.17 |
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 $22.39 Median $30.90 Typical High $38.90 | Professional | 52 · Reduced service | $22.39 | $30.90 | $38.90 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.91 Median $12.59 Typical High $15.85 | Professional | 53 · Discontinued | $8.91 | $12.59 | $15.85 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $33.11 Median $46.77 Typical High $58.88 | Professional | 54 · Surgery only | $33.11 | $46.77 | $58.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.61 Median $9.33 Typical High $11.75 | Professional | 55 · Aftercare only | $6.61 | $9.33 | $11.75 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.47 Median $6.31 Typical High $7.94 | Professional | 56 · Pre-op care only | $4.47 | $6.31 | $7.94 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $22.39 Median $30.90 Typical High $38.90 | Professional | 52 · Reduced service | $22.39 | $30.90 | $38.90 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $8.91 Median $12.59 Typical High $15.85 | Professional | 53 · Discontinued | $8.91 | $12.59 | $15.85 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $33.11 Median $46.77 Typical High $58.88 | Professional | 54 · Surgery only | $33.11 | $46.77 | $58.88 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $6.61 Median $9.33 Typical High $11.75 | Professional | 55 · Aftercare only | $6.61 | $9.33 | $11.75 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.47 Median $6.31 Typical High $7.94 | Professional | 56 · Pre-op care only | $4.47 | $6.31 | $7.94 |
Where Maine sits
The same service costs 2.8 times more in Alaska than in Pennsylvania. 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· 39th of 51
$102
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.