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 $54.95 Median $89.13 Typical High $123.03 | Professional | None | $54.95 | $89.13 | $123.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $66.07 Median $131.83 Typical High $275.42 | Professional | None | $66.07 | $131.83 | $275.42 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $109.65 Median $194.98 Typical High $416.87 | Professional | 50 · Both sides | $109.65 | $194.98 | $416.87 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,000.00 Typical High $1,412.54 | Facility | None | $537.03 | $1,000.00 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $158.49 Typical High $288.40 | Professional | None | $93.33 | $158.49 | $288.40 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $77.62 Median $154.88 Typical High $309.03 | Professional | None | $77.62 | $154.88 | $309.03 |
Martin's Point Setting Professional Modifier None Typical Low $54.95 Median $89.13 Typical High $123.03 | Professional | None | $54.95 | $89.13 | $123.03 |
United Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
United Setting Professional Modifier None Typical Low $91.20 Median $151.36 Typical High $263.03 | Professional | None | $91.20 | $151.36 | $263.03 |
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 $27.54 Median $33.88 Typical High $61.66 | Professional | 52 · Reduced service | $27.54 | $33.88 | $61.66 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.96 Median $13.49 Typical High $24.55 | Professional | 53 · Discontinued | $10.96 | $13.49 | $24.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $41.69 Median $51.29 Typical High $91.20 | Professional | 54 · Surgery only | $41.69 | $51.29 | $91.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.32 Median $10.23 Typical High $18.62 | Professional | 55 · Aftercare only | $8.32 | $10.23 | $18.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.50 Median $6.76 Typical High $12.30 | Professional | 56 · Pre-op care only | $5.50 | $6.76 | $12.30 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $27.54 Median $33.88 Typical High $61.66 | Professional | 52 · Reduced service | $27.54 | $33.88 | $61.66 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.96 Median $13.49 Typical High $24.55 | Professional | 53 · Discontinued | $10.96 | $13.49 | $24.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $41.69 Median $51.29 Typical High $91.20 | Professional | 54 · Surgery only | $41.69 | $51.29 | $91.20 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $8.32 Median $10.23 Typical High $18.62 | Professional | 55 · Aftercare only | $8.32 | $10.23 | $18.62 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.50 Median $6.76 Typical High $12.30 | Professional | 56 · Pre-op care only | $5.50 | $6.76 | $12.30 |
Where Maine sits
The same service costs 4.9 times more in Alaska than in Hawaii. 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· 45th of 51
$132
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.