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 $27.54 Median $70.79 Typical High $158.49 | Professional | None | $27.54 | $70.79 | $158.49 |
Anthem BCBS Setting Professional Modifier None Typical Low $32.36 Median $77.62 Typical High $162.18 | Professional | None | $32.36 | $77.62 | $162.18 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $38.02 Median $81.28 Typical High $190.55 | Professional | None | $38.02 | $81.28 | $190.55 |
Community Health Options Setting Professional Modifier None Typical Low $85.11 Median $144.54 Typical High $199.53 | Professional | None | $85.11 | $144.54 | $199.53 |
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 $81.28 Typical High $169.82 | Professional | None | $35.48 | $81.28 | $169.82 |
Martin's Point Setting Professional Modifier None Typical Low $27.54 Median $70.79 Typical High $158.49 | Professional | None | $27.54 | $70.79 | $158.49 |
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 $45.71 Median $77.62 Typical High $158.49 | Professional | None | $45.71 | $77.62 | $158.49 |
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 $13.80 Median $16.98 Typical High $39.81 | Professional | 52 · Reduced service | $13.80 | $16.98 | $39.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.50 Median $6.76 Typical High $16.22 | Professional | 53 · Discontinued | $5.50 | $6.76 | $16.22 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $20.89 Median $25.70 Typical High $60.26 | Professional | 54 · Surgery only | $20.89 | $25.70 | $60.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.17 Median $5.13 Typical High $12.02 | Professional | 55 · Aftercare only | $4.17 | $5.13 | $12.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.75 Median $3.39 Typical High $8.13 | Professional | 56 · Pre-op care only | $2.75 | $3.39 | $8.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $13.80 Median $16.98 Typical High $39.81 | Professional | 52 · Reduced service | $13.80 | $16.98 | $39.81 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $5.50 Median $6.76 Typical High $16.22 | Professional | 53 · Discontinued | $5.50 | $6.76 | $16.22 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $20.89 Median $25.70 Typical High $60.26 | Professional | 54 · Surgery only | $20.89 | $25.70 | $60.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $4.17 Median $5.13 Typical High $12.02 | Professional | 55 · Aftercare only | $4.17 | $5.13 | $12.02 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.75 Median $3.39 Typical High $8.13 | Professional | 56 · Pre-op care only | $2.75 | $3.39 | $8.13 |
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· 25th of 51
$81.28
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.