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 $1.70 Median $4.37 Typical High $10.47 | Professional | None | $1.70 | $4.37 | $10.47 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.29 Median $4.79 Typical High $12.59 | Professional | None | $2.29 | $4.79 | $12.59 |
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 $2.34 Median $6.61 Typical High $13.18 | Professional | None | $2.34 | $6.61 | $13.18 |
Community Health Options Setting Professional Modifier None Typical Low $5.75 Median $10.96 Typical High $13.49 | Professional | None | $5.75 | $10.96 | $13.49 |
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 $2.40 Median $5.75 Typical High $10.96 | Professional | None | $2.40 | $5.75 | $10.96 |
Martin's Point Setting Professional Modifier None Typical Low $1.70 Median $4.37 Typical High $10.47 | Professional | None | $1.70 | $4.37 | $10.47 |
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 $3.16 Median $5.75 Typical High $10.00 | Professional | None | $3.16 | $5.75 | $10.00 |
9 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 $0.85 Median $1.82 Typical High $2.45 | Professional | 52 · Reduced service | $0.85 | $1.82 | $2.45 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.34 Median $0.72 Typical High $0.98 | Professional | 53 · Discontinued | $0.34 | $0.72 | $0.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1.29 Median $2.69 Typical High $3.63 | Professional | 54 · Surgery only | $1.29 | $2.69 | $3.63 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.26 Median $0.54 Typical High $0.72 | Professional | 55 · Aftercare only | $0.26 | $0.54 | $0.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.17 Median $0.36 Typical High $0.49 | Professional | 56 · Pre-op care only | $0.17 | $0.36 | $0.49 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $0.85 Median $1.02 Typical High $2.45 | Professional | 52 · Reduced service | $0.85 | $1.02 | $2.45 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.34 Median $0.41 Typical High $0.98 | Professional | 53 · Discontinued | $0.34 | $0.41 | $0.98 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1.29 Median $1.51 Typical High $3.63 | Professional | 54 · Surgery only | $1.29 | $1.51 | $3.63 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.26 Median $0.31 Typical High $0.72 | Professional | 55 · Aftercare only | $0.26 | $0.31 | $0.72 |
Where Maine sits
The same service costs 3.0 times more in Alaska than in Nebraska. 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· 50th of 51
$4.79
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.