How much rates vary
Facilitymedian $490 · 10th to 90th $380 to $813Professionalmedian $138 · 10th to 90th $107 to $204
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $109.65 Median $128.82 Typical High $128.82 | Professional | None | $109.65 | $128.82 | $128.82 |
Anthem BCBS Setting Facility Modifier None Typical Low $380.19 Median $489.78 Typical High $501.19 | Facility | None | $380.19 | $489.78 | $501.19 |
Anthem BCBS Setting Professional Modifier None Typical Low $102.33 Median $147.91 Typical High $213.80 | Professional | None | $102.33 | $147.91 | $213.80 |
Cigna Setting Facility Modifier None Typical Low $151.36 Median $707.95 Typical High $2,290.87 | Facility | None | $151.36 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $134.90 Median $151.36 Typical High $229.09 | Professional | None | $134.90 | $151.36 | $229.09 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $107.15 Median $138.04 Typical High $194.98 | Professional | None | $107.15 | $138.04 | $194.98 |
Martin's Point Setting Professional Modifier None Typical Low $120.23 Median $128.82 Typical High $128.82 | Professional | None | $120.23 | $128.82 | $128.82 |
United Setting Facility Modifier None Typical Low $776.25 Median $812.83 Typical High $1,202.26 | Facility | None | $776.25 | $812.83 | $1,202.26 |
United Setting Professional Modifier None Typical Low $104.71 Median $147.91 Typical High $204.17 | Professional | None | $104.71 | $147.91 | $204.17 |
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 $53.70 Median $64.57 Typical High $64.57 | Professional | 52 · Reduced service | $53.70 | $64.57 | $64.57 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $25.70 Typical High $25.70 | Professional | 53 · Discontinued | $21.88 | $25.70 | $25.70 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $95.50 Typical High $95.50 | Professional | 54 · Surgery only | $81.28 | $95.50 | $95.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $19.05 Typical High $19.05 | Professional | 55 · Aftercare only | $16.22 | $19.05 | $19.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $12.88 Typical High $12.88 | Professional | 56 · Pre-op care only | $10.96 | $12.88 | $12.88 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $60.26 Median $64.57 Typical High $64.57 | Professional | 52 · Reduced service | $60.26 | $64.57 | $64.57 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $25.70 Typical High $25.70 | Professional | 53 · Discontinued | $23.99 | $25.70 | $25.70 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $91.20 Median $95.50 Typical High $95.50 | Professional | 54 · Surgery only | $91.20 | $95.50 | $95.50 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $18.20 Median $19.05 Typical High $19.05 | Professional | 55 · Aftercare only | $18.20 | $19.05 | $19.05 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $12.88 Typical High $12.88 | Professional | 56 · Pre-op care only | $12.02 | $12.88 | $12.88 |
Where Maine sits
The same service costs 4.4 times more in Alaska than in New Jersey. 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· 24th of 51
$148
AK $427NJ $97.72
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.