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 $37.15 Median $74.13 Typical High $158.49 | Professional | None | $37.15 | $74.13 | $158.49 |
Anthem BCBS Setting Professional Modifier None Typical Low $45.71 Median $85.11 Typical High $186.21 | Professional | None | $45.71 | $85.11 | $186.21 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $134.90 Typical High $707.95 | Facility | None | $56.23 | $134.90 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $50.12 Median $104.71 Typical High $218.78 | Professional | None | $50.12 | $104.71 | $218.78 |
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 $47.86 Median $102.33 Typical High $199.53 | Professional | None | $47.86 | $102.33 | $199.53 |
Martin's Point Setting Professional Modifier None Typical Low $37.15 Median $79.43 Typical High $158.49 | Professional | None | $37.15 | $79.43 | $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 $61.66 Median $93.33 Typical High $186.21 | Professional | None | $61.66 | $93.33 | $186.21 |
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 $18.62 Median $22.91 Typical High $46.77 | Professional | 52 · Reduced service | $18.62 | $22.91 | $46.77 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $9.12 Typical High $18.62 | Professional | 53 · Discontinued | $7.41 | $9.12 | $18.62 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $28.18 Median $33.88 Typical High $69.18 | Professional | 54 · Surgery only | $28.18 | $33.88 | $69.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $6.76 Typical High $13.80 | Professional | 55 · Aftercare only | $5.62 | $6.76 | $13.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.72 Median $4.57 Typical High $9.33 | Professional | 56 · Pre-op care only | $3.72 | $4.57 | $9.33 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $18.62 Median $22.91 Typical High $46.77 | Professional | 52 · Reduced service | $18.62 | $22.91 | $46.77 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $9.12 Typical High $18.62 | Professional | 53 · Discontinued | $7.41 | $9.12 | $18.62 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $28.18 Median $33.88 Typical High $69.18 | Professional | 54 · Surgery only | $28.18 | $33.88 | $69.18 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $6.76 Typical High $13.80 | Professional | 55 · Aftercare only | $5.62 | $6.76 | $13.80 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.72 Median $4.57 Typical High $9.33 | Professional | 56 · Pre-op care only | $3.72 | $4.57 | $9.33 |
Where Maine sits
The same service costs 3.5 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· 31st of 51
$93.33
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.