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 $162.18 Typical High $162.18 | Professional | None | $158.49 | $162.18 | $162.18 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,023.29 Median $1,023.29 Typical High $1,023.29 | Facility | None | $1,023.29 | $1,023.29 | $1,023.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $128.82 Median $190.55 Typical High $269.15 | Professional | None | $128.82 | $190.55 | $269.15 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,202.26 Typical High $1,621.81 | Facility | None | $537.03 | $1,202.26 | $1,621.81 |
Cigna Setting Professional Modifier None Typical Low $177.83 Median $194.98 Typical High $316.23 | Professional | None | $177.83 | $194.98 | $316.23 |
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 $138.04 Median $181.97 Typical High $263.03 | Professional | None | $138.04 | $181.97 | $263.03 |
Martin's Point Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
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 $131.83 Median $194.98 Typical High $269.15 | Professional | None | $131.83 | $194.98 | $269.15 |
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 $79.43 Median $81.28 Typical High $81.28 | Professional | 52 · Reduced service | $79.43 | $81.28 | $81.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $31.62 Median $33.11 Typical High $33.11 | Professional | 53 · Discontinued | $31.62 | $33.11 | $33.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $120.23 Median $123.03 Typical High $123.03 | Professional | 54 · Surgery only | $120.23 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $24.55 Typical High $24.55 | Professional | 55 · Aftercare only | $23.99 | $24.55 | $24.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.85 Median $16.22 Typical High $16.22 | Professional | 56 · Pre-op care only | $15.85 | $16.22 | $16.22 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $81.28 Median $81.28 Typical High $81.28 | Professional | 52 · Reduced service | $81.28 | $81.28 | $81.28 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $33.11 Typical High $33.11 | Professional | 53 · Discontinued | $32.36 | $33.11 | $33.11 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $123.03 Typical High $123.03 | Professional | 54 · Surgery only | $123.03 | $123.03 | $123.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $24.55 Typical High $24.55 | Professional | 55 · Aftercare only | $24.55 | $24.55 | $24.55 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $16.22 Median $16.22 Typical High $16.22 | Professional | 56 · Pre-op care only | $16.22 | $16.22 | $16.22 |
Where Maine sits
The same service costs 5.4 times more in Alaska than in Utah. 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· 36th of 51
$186
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.