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 $128.82 Median $144.54 Typical High $144.54 | Professional | None | $128.82 | $144.54 | $144.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $120.23 Median $141.25 Typical High $199.53 | Professional | None | $120.23 | $141.25 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $891.25 Typical High $2,290.87 | Facility | None | $707.95 | $891.25 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $138.04 Median $162.18 Typical High $269.15 | Professional | None | $138.04 | $162.18 | $269.15 |
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 $123.03 Median $165.96 Typical High $234.42 | Professional | None | $123.03 | $165.96 | $234.42 |
Martin's Point Setting Professional Modifier None Typical Low $141.25 Median $144.54 Typical High $144.54 | Professional | None | $141.25 | $144.54 | $144.54 |
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 $117.49 Median $165.96 Typical High $245.47 | Professional | None | $117.49 | $165.96 | $245.47 |
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 $64.57 Median $72.44 Typical High $72.44 | Professional | 52 · Reduced service | $64.57 | $72.44 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.70 Median $28.84 Typical High $28.84 | Professional | 53 · Discontinued | $25.70 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $97.72 Median $109.65 Typical High $109.65 | Professional | 54 · Surgery only | $97.72 | $109.65 | $109.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.50 Median $21.88 Typical High $21.88 | Professional | 55 · Aftercare only | $19.50 | $21.88 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.88 Median $14.45 Typical High $14.45 | Professional | 56 · Pre-op care only | $12.88 | $14.45 | $14.45 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $70.79 Median $72.44 Typical High $72.44 | Professional | 52 · Reduced service | $70.79 | $72.44 | $72.44 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $28.84 Typical High $28.84 | Professional | 53 · Discontinued | $28.18 | $28.84 | $28.84 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $109.65 Typical High $109.65 | Professional | 54 · Surgery only | $107.15 | $109.65 | $109.65 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $21.88 Typical High $21.88 | Professional | 55 · Aftercare only | $21.38 | $21.88 | $21.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $14.45 Typical High $14.45 | Professional | 56 · Pre-op care only | $14.13 | $14.45 | $14.45 |
Where Maine sits
The same service costs 6.0 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· 34th of 51
$145
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.