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 $467.74 Median $501.19 Typical High $501.19 | Professional | None | $467.74 | $501.19 | $501.19 |
Anthem BCBS Setting Professional Modifier None Typical Low $389.05 Median $537.03 Typical High $812.83 | Professional | None | $389.05 | $537.03 | $812.83 |
Cigna Setting Facility Modifier None Typical Low $2,137.96 Median $5,754.40 Typical High $8,317.64 | Facility | None | $2,137.96 | $5,754.40 | $8,317.64 |
Cigna Setting Professional Modifier None Typical Low $478.63 Median $588.84 Typical High $891.25 | Professional | None | $478.63 | $588.84 | $891.25 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $416.87 Median $537.03 Typical High $776.25 | Professional | None | $416.87 | $537.03 | $776.25 |
Martin's Point Setting Professional Modifier None Typical Low $467.74 Median $501.19 Typical High $501.19 | Professional | None | $467.74 | $501.19 | $501.19 |
United Setting Facility Modifier None Typical Low $1,513.56 Median $2,238.72 Typical High $3,890.45 | Facility | None | $1,513.56 | $2,238.72 | $3,890.45 |
United Setting Professional Modifier None Typical Low $407.38 Median $575.44 Typical High $794.33 | Professional | None | $407.38 | $575.44 | $794.33 |
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 $229.09 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $229.09 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $100.00 Typical High $100.00 | Professional | 53 · Discontinued | $93.33 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $346.74 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $346.74 | $371.54 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $69.18 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $69.18 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $50.12 Typical High $50.12 | Professional | 56 · Pre-op care only | $46.77 | $50.12 | $50.12 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $229.09 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $229.09 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $100.00 Typical High $100.00 | Professional | 53 · Discontinued | $93.33 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $346.74 Median $371.54 Typical High $371.54 | Professional | 54 · Surgery only | $346.74 | $371.54 | $371.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $69.18 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $69.18 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $50.12 Typical High $50.12 | Professional | 56 · Pre-op care only | $46.77 | $50.12 | $50.12 |
Where Maine sits
The same service costs 4.5 times more in Alaska than in Texas. 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· 30th of 51
$537
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.