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 $380.19 Median $1,949.84 Typical High $11,481.54 | Facility | None | $380.19 | $1,949.84 | $11,481.54 |
Aetna Setting Professional Modifier None Typical Low $346.74 Median $1,348.96 Typical High $2,089.30 | Professional | None | $346.74 | $1,348.96 | $2,089.30 |
Ambetter Setting Professional Modifier 50 · Both sides Typical Low $794.33 Median $794.33 Typical High $794.33 | Professional | 50 · Both sides | $794.33 | $794.33 | $794.33 |
Anthem BCBS Setting Facility Modifier None Typical Low $5,011.87 Median $5,623.41 Typical High $9,332.54 | Facility | None | $5,011.87 | $5,623.41 | $9,332.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $323.59 Median $1,047.13 Typical High $4,073.80 | Professional | None | $323.59 | $1,047.13 | $4,073.80 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $891.25 Median $1,584.89 Typical High $6,918.31 | Professional | 50 · Both sides | $891.25 | $1,584.89 | $6,918.31 |
Cigna Setting Professional Modifier None Typical Low $436.52 Median $1,513.56 Typical High $4,786.30 | Professional | None | $436.52 | $1,513.56 | $4,786.30 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $12,302.69 Median $12,302.69 Typical High $12,302.69 | Facility | None | $12,302.69 | $12,302.69 | $12,302.69 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $398.11 Median $1,995.26 Typical High $6,456.54 | Professional | None | $398.11 | $1,995.26 | $6,456.54 |
United Setting Facility Modifier None Typical Low $12,302.69 Median $12,302.69 Typical High $12,302.69 | Facility | None | $12,302.69 | $12,302.69 | $12,302.69 |
United Setting Professional Modifier None Typical Low $489.78 Median $1,995.26 Typical High $4,677.35 | Professional | None | $489.78 | $1,995.26 | $4,677.35 |
5 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 $117.49 Median $676.08 Typical High $977.24 | Professional | 52 · Reduced service | $117.49 | $676.08 | $977.24 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $47.86 Median $269.15 Typical High $398.11 | Professional | 53 · Discontinued | $47.86 | $269.15 | $398.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $177.83 Median $1,000.00 Typical High $1,479.11 | Professional | 54 · Surgery only | $177.83 | $1,000.00 | $1,479.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $199.53 Typical High $295.12 | Professional | 55 · Aftercare only | $35.48 | $199.53 | $295.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.99 Median $134.90 Typical High $194.98 | Professional | 56 · Pre-op care only | $23.99 | $134.90 | $194.98 |
Where New Hampshire sits
The same service costs 6.2 times more in Washington than in Maryland. 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.
New Hampshire· 43rd of 51
$1,413
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.