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 Facility Modifier None Typical Low $147.91 Median $147.91 Typical High $147.91 | Facility | None | $147.91 | $147.91 | $147.91 |
Aetna Setting Professional Modifier None Typical Low $120.23 Median $147.91 Typical High $302.00 | Professional | None | $120.23 | $147.91 | $302.00 |
Anthem BCBS Setting Professional Modifier None Typical Low $114.82 Median $141.25 Typical High $204.17 | Professional | None | $114.82 | $141.25 | $204.17 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $707.95 Typical High $7,079.46 | Facility | None | $691.83 | $707.95 | $7,079.46 |
Cigna Setting Professional Modifier None Typical Low $120.23 Median $162.18 Typical High $234.42 | Professional | None | $120.23 | $162.18 | $234.42 |
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 $114.82 Median $151.36 Typical High $229.09 | Professional | None | $114.82 | $151.36 | $229.09 |
Martin's Point Setting Professional Modifier None Typical Low $120.23 Median $147.91 Typical High $302.00 | Professional | None | $120.23 | $147.91 | $302.00 |
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 $107.15 Median $151.36 Typical High $229.09 | Professional | None | $107.15 | $151.36 | $229.09 |
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 $61.66 Median $74.13 Typical High $74.13 | Professional | 52 · Reduced service | $61.66 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $29.51 Typical High $29.51 | Professional | 53 · Discontinued | $24.55 | $29.51 | $29.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $112.20 Typical High $112.20 | Professional | 54 · Surgery only | $91.20 | $112.20 | $112.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $22.39 Typical High $22.39 | Professional | 55 · Aftercare only | $18.20 | $22.39 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $14.79 Typical High $14.79 | Professional | 56 · Pre-op care only | $12.30 | $14.79 | $14.79 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $69.18 Median $74.13 Typical High $74.13 | Professional | 52 · Reduced service | $69.18 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $27.54 Median $29.51 Typical High $29.51 | Professional | 53 · Discontinued | $27.54 | $29.51 | $29.51 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $112.20 Typical High $112.20 | Professional | 54 · Surgery only | $102.33 | $112.20 | $112.20 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $22.39 Typical High $22.39 | Professional | 55 · Aftercare only | $20.42 | $22.39 | $22.39 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $13.80 Median $14.79 Typical High $14.79 | Professional | 56 · Pre-op care only | $13.80 | $14.79 | $14.79 |
Where Maine sits
The same service costs 4.0 times more in Alaska than in Delaware. 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· 34th of 51
$148
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.