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 $158.49 Median $416.87 Typical High $1,071.52 | Professional | None | $158.49 | $416.87 | $1,071.52 |
Anthem BCBS Setting Professional Modifier None Typical Low $181.97 Median $512.86 Typical High $1,230.27 | Professional | None | $181.97 | $512.86 | $1,230.27 |
Cigna Setting Facility Modifier None Typical Low $645.65 Median $758.58 Typical High $1,148.15 | Facility | None | $645.65 | $758.58 | $1,148.15 |
Cigna Setting Professional Modifier None Typical Low $223.87 Median $524.81 Typical High $1,318.26 | Professional | None | $223.87 | $524.81 | $1,318.26 |
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 $181.97 Median $575.44 Typical High $1,318.26 | Professional | None | $181.97 | $575.44 | $1,318.26 |
Martin's Point Setting Professional Modifier None Typical Low $158.49 Median $416.87 Typical High $1,071.52 | Professional | None | $158.49 | $416.87 | $1,071.52 |
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 $186.21 Median $562.34 Typical High $1,230.27 | Professional | None | $186.21 | $562.34 | $1,230.27 |
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 $93.33 Median $128.82 Typical High $524.81 | Professional | 52 · Reduced service | $93.33 | $128.82 | $524.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $51.29 Typical High $213.80 | Professional | 53 · Discontinued | $38.02 | $51.29 | $213.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $141.25 Median $190.55 Typical High $794.33 | Professional | 54 · Surgery only | $141.25 | $190.55 | $794.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.18 Median $38.90 Typical High $158.49 | Professional | 55 · Aftercare only | $28.18 | $38.90 | $158.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $25.70 Typical High $107.15 | Professional | 56 · Pre-op care only | $18.62 | $25.70 | $107.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $112.20 Median $128.82 Typical High $524.81 | Professional | 52 · Reduced service | $112.20 | $128.82 | $524.81 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $44.67 Median $51.29 Typical High $213.80 | Professional | 53 · Discontinued | $44.67 | $51.29 | $213.80 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $169.82 Median $190.55 Typical High $794.33 | Professional | 54 · Surgery only | $169.82 | $190.55 | $794.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $38.90 Typical High $158.49 | Professional | 55 · Aftercare only | $33.88 | $38.90 | $158.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $25.70 Median $41.69 Typical High $107.15 | Professional | 56 · Pre-op care only | $25.70 | $41.69 | $107.15 |
Where Maine sits
The same service costs 5.2 times more in Wisconsin than in Hawaii. 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· 39th of 51
$550
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.