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 $204.17 Median $251.19 Typical High $295.12 | Professional | None | $204.17 | $251.19 | $295.12 |
Anthem BCBS Setting Professional Modifier None Typical Low $223.87 Median $398.11 Typical High $707.95 | Professional | None | $223.87 | $398.11 | $707.95 |
Cigna Setting Facility Modifier None Typical Low $257.04 Median $575.44 Typical High $2,290.87 | Facility | None | $257.04 | $575.44 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $426.58 Typical High $724.44 | Professional | None | $281.84 | $426.58 | $724.44 |
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 $281.84 Median $416.87 Typical High $758.58 | Professional | None | $281.84 | $416.87 | $758.58 |
Martin's Point Setting Professional Modifier None Typical Low $204.17 Median $257.04 Typical High $295.12 | Professional | None | $204.17 | $257.04 | $295.12 |
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 $302.00 Median $398.11 Typical High $616.60 | Professional | None | $302.00 | $398.11 | $616.60 |
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 $102.33 Median $125.89 Typical High $147.91 | Professional | 52 · Reduced service | $102.33 | $125.89 | $147.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $50.12 Typical High $58.88 | Professional | 53 · Discontinued | $40.74 | $50.12 | $58.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $186.21 Typical High $223.87 | Professional | 54 · Surgery only | $154.88 | $186.21 | $223.87 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $38.02 Typical High $44.67 | Professional | 55 · Aftercare only | $30.90 | $38.02 | $44.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $25.12 Typical High $29.51 | Professional | 56 · Pre-op care only | $20.42 | $25.12 | $29.51 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $102.33 Median $128.82 Typical High $147.91 | Professional | 52 · Reduced service | $102.33 | $128.82 | $147.91 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $51.29 Typical High $58.88 | Professional | 53 · Discontinued | $40.74 | $51.29 | $58.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $194.98 Typical High $223.87 | Professional | 54 · Surgery only | $154.88 | $194.98 | $223.87 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $38.90 Typical High $44.67 | Professional | 55 · Aftercare only | $30.90 | $38.90 | $44.67 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $25.70 Typical High $29.51 | Professional | 56 · Pre-op care only | $20.42 | $25.70 | $29.51 |
Where Maine sits
The same service costs 4.0 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· 17th of 51
$398
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.