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 $25.70 Median $57.54 Typical High $74.13 | Professional | None | $25.70 | $57.54 | $74.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $30.20 Median $61.66 Typical High $125.89 | Professional | None | $30.20 | $61.66 | $125.89 |
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 $34.67 Median $81.28 Typical High $134.90 | Professional | None | $34.67 | $81.28 | $134.90 |
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 $35.48 Median $69.18 Typical High $134.90 | Professional | None | $35.48 | $69.18 | $134.90 |
Martin's Point Setting Professional Modifier None Typical Low $25.70 Median $57.54 Typical High $75.86 | Professional | None | $25.70 | $57.54 | $75.86 |
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 $42.66 Median $67.61 Typical High $123.03 | Professional | None | $42.66 | $67.61 | $123.03 |
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 $12.88 Median $15.49 Typical High $28.84 | Professional | 52 · Reduced service | $12.88 | $15.49 | $28.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.13 Median $6.17 Typical High $11.48 | Professional | 53 · Discontinued | $5.13 | $6.17 | $11.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $19.05 Median $22.91 Typical High $43.65 | Professional | 54 · Surgery only | $19.05 | $22.91 | $43.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.80 Median $4.57 Typical High $8.71 | Professional | 55 · Aftercare only | $3.80 | $4.57 | $8.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.51 Median $3.09 Typical High $5.75 | Professional | 56 · Pre-op care only | $2.51 | $3.09 | $5.75 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $12.88 Median $15.49 Typical High $28.84 | Professional | 52 · Reduced service | $12.88 | $15.49 | $28.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $5.13 Median $6.17 Typical High $11.48 | Professional | 53 · Discontinued | $5.13 | $6.17 | $11.48 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $19.05 Median $22.91 Typical High $43.65 | Professional | 54 · Surgery only | $19.05 | $22.91 | $43.65 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.80 Median $4.57 Typical High $8.71 | Professional | 55 · Aftercare only | $3.80 | $4.57 | $8.71 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.51 Median $3.09 Typical High $5.75 | Professional | 56 · Pre-op care only | $2.51 | $3.09 | $5.75 |
Where Maine sits
The same service costs 3.3 times more in Alaska 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· 48th of 51
$57.54
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.