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 $194.98 Median $194.98 Typical High $371.54 | Professional | None | $194.98 | $194.98 | $371.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $154.88 Median $302.00 Typical High $575.44 | Professional | None | $154.88 | $302.00 | $575.44 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $257.04 Median $457.09 Typical High $891.25 | Professional | 50 · Both sides | $257.04 | $457.09 | $891.25 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,148.15 Typical High $1,513.56 | Facility | None | $537.03 | $1,148.15 | $1,513.56 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $371.54 Typical High $602.56 | Professional | None | $204.17 | $371.54 | $602.56 |
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 $173.78 Median $316.23 Typical High $588.84 | Professional | None | $173.78 | $316.23 | $588.84 |
Martin's Point Setting Professional Modifier None Typical Low $194.98 Median $194.98 Typical High $371.54 | Professional | None | $194.98 | $194.98 | $371.54 |
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 $213.80 Median $316.23 Typical High $537.03 | Professional | None | $213.80 | $316.23 | $537.03 |
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 $97.72 Median $97.72 Typical High $186.21 | Professional | 52 · Reduced service | $97.72 | $97.72 | $186.21 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $38.90 Typical High $74.13 | Professional | 53 · Discontinued | $38.90 | $38.90 | $74.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $147.91 Typical High $275.42 | Professional | 54 · Surgery only | $147.91 | $147.91 | $275.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $29.51 Typical High $54.95 | Professional | 55 · Aftercare only | $29.51 | $29.51 | $54.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $19.50 Typical High $37.15 | Professional | 56 · Pre-op care only | $19.50 | $19.50 | $37.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $97.72 Median $97.72 Typical High $186.21 | Professional | 52 · Reduced service | $97.72 | $97.72 | $186.21 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $38.90 Typical High $74.13 | Professional | 53 · Discontinued | $38.90 | $38.90 | $74.13 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $147.91 Typical High $275.42 | Professional | 54 · Surgery only | $147.91 | $147.91 | $275.42 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $29.51 Typical High $54.95 | Professional | 55 · Aftercare only | $29.51 | $29.51 | $54.95 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $19.50 Typical High $37.15 | Professional | 56 · Pre-op care only | $19.50 | $19.50 | $37.15 |
Where Maine sits
The same service costs 3.9 times more in Alaska than in Kentucky. 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· 40th of 51
$309
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.