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 $41.69 Median $52.48 Typical High $63.10 | Professional | None | $41.69 | $52.48 | $63.10 |
Anthem BCBS Setting Professional Modifier None Typical Low $46.77 Median $83.18 Typical High $154.88 | Professional | None | $46.77 | $83.18 | $154.88 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $91.20 Typical High $707.95 | Facility | None | $56.23 | $91.20 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $57.54 Median $89.13 Typical High $158.49 | Professional | None | $57.54 | $89.13 | $158.49 |
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 $54.95 Median $95.50 Typical High $165.96 | Professional | None | $54.95 | $95.50 | $165.96 |
Martin's Point Setting Professional Modifier None Typical Low $41.69 Median $52.48 Typical High $63.10 | Professional | None | $41.69 | $52.48 | $63.10 |
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 $67.61 Median $95.50 Typical High $131.83 | Professional | None | $67.61 | $95.50 | $131.83 |
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 $20.89 Median $26.30 Typical High $31.62 | Professional | 52 · Reduced service | $20.89 | $26.30 | $31.62 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.32 Median $10.47 Typical High $12.59 | Professional | 53 · Discontinued | $8.32 | $10.47 | $12.59 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $31.62 Median $39.81 Typical High $47.86 | Professional | 54 · Surgery only | $31.62 | $39.81 | $47.86 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.31 Median $7.94 Typical High $9.55 | Professional | 55 · Aftercare only | $6.31 | $7.94 | $9.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.17 Median $5.25 Typical High $6.31 | Professional | 56 · Pre-op care only | $4.17 | $5.25 | $6.31 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $20.89 Median $26.30 Typical High $31.62 | Professional | 52 · Reduced service | $20.89 | $26.30 | $31.62 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $8.32 Median $10.47 Typical High $12.59 | Professional | 53 · Discontinued | $8.32 | $10.47 | $12.59 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $31.62 Median $39.81 Typical High $47.86 | Professional | 54 · Surgery only | $31.62 | $39.81 | $47.86 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $6.31 Median $7.94 Typical High $9.55 | Professional | 55 · Aftercare only | $6.31 | $7.94 | $9.55 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.17 Median $5.25 Typical High $6.31 | Professional | 56 · Pre-op care only | $4.17 | $5.25 | $6.31 |
Where Maine sits
The same service costs 3.4 times more in Alaska than in New York. 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· 24th of 51
$83.18
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.