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 $165.96 Median $165.96 Typical High $371.54 | Professional | None | $165.96 | $165.96 | $371.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $104.71 Median $208.93 Typical High $436.52 | Professional | None | $104.71 | $208.93 | $436.52 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $870.96 Typical High $1,862.09 | Facility | None | $707.95 | $870.96 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $234.42 Typical High $446.68 | Professional | None | $147.91 | $234.42 | $446.68 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $141.25 Median $208.93 Typical High $467.74 | Professional | None | $141.25 | $208.93 | $467.74 |
Martin's Point Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $371.54 | Professional | None | $165.96 | $165.96 | $371.54 |
United Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
United Setting Professional Modifier None Typical Low $147.91 Median $208.93 Typical High $371.54 | Professional | None | $147.91 | $208.93 | $371.54 |
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 $83.18 Median $83.18 Typical High $186.21 | Professional | 52 · Reduced service | $83.18 | $83.18 | $186.21 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.11 Median $33.11 Typical High $74.13 | Professional | 53 · Discontinued | $33.11 | $33.11 | $74.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $125.89 Median $125.89 Typical High $281.84 | Professional | 54 · Surgery only | $125.89 | $125.89 | $281.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.12 Median $25.12 Typical High $56.23 | Professional | 55 · Aftercare only | $25.12 | $25.12 | $56.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.60 Median $16.60 Typical High $37.15 | Professional | 56 · Pre-op care only | $16.60 | $16.60 | $37.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $83.18 Median $83.18 Typical High $186.21 | Professional | 52 · Reduced service | $83.18 | $83.18 | $186.21 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $33.11 Median $33.11 Typical High $74.13 | Professional | 53 · Discontinued | $33.11 | $33.11 | $74.13 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $125.89 Median $125.89 Typical High $281.84 | Professional | 54 · Surgery only | $125.89 | $125.89 | $281.84 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $25.12 Median $25.12 Typical High $56.23 | Professional | 55 · Aftercare only | $25.12 | $25.12 | $56.23 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $16.60 Median $16.60 Typical High $37.15 | Professional | 56 · Pre-op care only | $16.60 | $16.60 | $37.15 |
Where Maine sits
The same service costs 4.3 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· 46th of 51
$224
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.