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 $117.49 Median $194.98 Typical High $223.87 | Professional | None | $117.49 | $194.98 | $223.87 |
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 $114.82 Median $199.53 Typical High $380.19 | Professional | None | $114.82 | $199.53 | $380.19 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,584.89 Typical High $2,570.40 | Facility | None | $537.03 | $1,584.89 | $2,570.40 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $229.09 Typical High $407.38 | Professional | None | $134.90 | $229.09 | $407.38 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $117.49 Median $190.55 Typical High $426.58 | Professional | None | $117.49 | $190.55 | $426.58 |
Martin's Point Setting Professional Modifier None Typical Low $117.49 Median $199.53 Typical High $223.87 | Professional | None | $117.49 | $199.53 | $223.87 |
United Setting Facility Modifier None Typical Low $1,071.52 Median $1,778.28 Typical High $3,311.31 | Facility | None | $1,071.52 | $1,778.28 | $3,311.31 |
United Setting Professional Modifier None Typical Low $97.72 Median $190.55 Typical High $371.54 | Professional | None | $97.72 | $190.55 | $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 $58.88 Median $97.72 Typical High $112.20 | Professional | 52 · Reduced service | $58.88 | $97.72 | $112.20 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.44 Median $38.90 Typical High $44.67 | Professional | 53 · Discontinued | $23.44 | $38.90 | $44.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $147.91 Typical High $169.82 | Professional | 54 · Surgery only | $87.10 | $147.91 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $29.51 Typical High $33.88 | Professional | 55 · Aftercare only | $17.38 | $29.51 | $33.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.75 Median $19.50 Typical High $22.39 | Professional | 56 · Pre-op care only | $11.75 | $19.50 | $22.39 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $58.88 Median $100.00 Typical High $112.20 | Professional | 52 · Reduced service | $58.88 | $100.00 | $112.20 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $23.44 Median $39.81 Typical High $44.67 | Professional | 53 · Discontinued | $23.44 | $39.81 | $44.67 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $87.10 Median $147.91 Typical High $169.82 | Professional | 54 · Surgery only | $87.10 | $147.91 | $169.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $29.51 Typical High $33.88 | Professional | 55 · Aftercare only | $17.38 | $29.51 | $33.88 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $11.75 Median $19.95 Typical High $22.39 | Professional | 56 · Pre-op care only | $11.75 | $19.95 | $22.39 |
Where Maine sits
The same service costs 4.0 times more in Alaska than in Washington, DC. 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· 26th of 51
$200
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.