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 $141.25 Median $144.54 Typical High $331.13 | Professional | None | $141.25 | $144.54 | $331.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $117.49 Median $229.09 Typical High $501.19 | Professional | None | $117.49 | $229.09 | $501.19 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,148.15 Typical High $1,862.09 | Facility | None | $707.95 | $1,148.15 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $154.88 Median $275.42 Typical High $512.86 | Professional | None | $154.88 | $275.42 | $512.86 |
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 $128.82 Median $257.04 Typical High $512.86 | Professional | None | $128.82 | $257.04 | $512.86 |
Martin's Point Setting Professional Modifier None Typical Low $141.25 Median $144.54 Typical High $331.13 | Professional | None | $141.25 | $144.54 | $331.13 |
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 $162.18 Median $239.88 Typical High $457.09 | Professional | None | $162.18 | $239.88 | $457.09 |
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 $72.44 Median $72.44 Typical High $165.96 | Professional | 52 · Reduced service | $72.44 | $72.44 | $165.96 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $28.84 Typical High $66.07 | Professional | 53 · Discontinued | $28.84 | $28.84 | $66.07 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $109.65 Typical High $251.19 | Professional | 54 · Surgery only | $109.65 | $109.65 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $21.88 Typical High $50.12 | Professional | 55 · Aftercare only | $21.88 | $21.88 | $50.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $14.45 Typical High $33.11 | Professional | 56 · Pre-op care only | $14.45 | $14.45 | $33.11 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $72.44 Median $72.44 Typical High $165.96 | Professional | 52 · Reduced service | $72.44 | $72.44 | $165.96 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $28.84 Typical High $66.07 | Professional | 53 · Discontinued | $28.84 | $28.84 | $66.07 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $109.65 Typical High $251.19 | Professional | 54 · Surgery only | $109.65 | $109.65 | $251.19 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.88 Median $21.88 Typical High $50.12 | Professional | 55 · Aftercare only | $21.88 | $21.88 | $50.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $14.45 Typical High $33.11 | Professional | 56 · Pre-op care only | $14.45 | $14.45 | $33.11 |
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
$257
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.