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 $407.38 Median $489.78 Typical High $489.78 | Professional | None | $407.38 | $489.78 | $489.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $380.19 Median $467.74 Typical High $645.65 | Professional | None | $380.19 | $467.74 | $645.65 |
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 $371.54 Median $537.03 Typical High $794.33 | Professional | None | $371.54 | $537.03 | $794.33 |
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 $380.19 Median $489.78 Typical High $707.95 | Professional | None | $380.19 | $489.78 | $707.95 |
Martin's Point Setting Professional Modifier None Typical Low $457.09 Median $489.78 Typical High $489.78 | Professional | None | $457.09 | $489.78 | $489.78 |
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 $354.81 Median $489.78 Typical High $776.25 | Professional | None | $354.81 | $489.78 | $776.25 |
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 $199.53 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $199.53 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $97.72 Typical High $97.72 | Professional | 53 · Discontinued | $81.28 | $97.72 | $97.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $302.00 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $302.00 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $60.26 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $60.26 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $48.98 Typical High $48.98 | Professional | 56 · Pre-op care only | $40.74 | $48.98 | $48.98 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $229.09 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $229.09 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $91.20 Median $97.72 Typical High $97.72 | Professional | 53 · Discontinued | $91.20 | $97.72 | $97.72 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $346.74 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $346.74 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $69.18 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $69.18 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $45.71 Median $48.98 Typical High $48.98 | Professional | 56 · Pre-op care only | $45.71 | $48.98 | $48.98 |
Where Maine sits
The same service costs 4.6 times more in Alaska than in Florida. 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· 29th of 51
$490
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.