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 $74.13 Median $74.13 Typical High $74.13 | Professional | None | $74.13 | $74.13 | $74.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $67.61 Median $104.71 Typical High $141.25 | Professional | None | $67.61 | $104.71 | $141.25 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $100.00 Median $158.49 Typical High $213.80 | Professional | 50 · Both sides | $100.00 | $158.49 | $213.80 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,412.54 Typical High $2,238.72 | Facility | None | $537.03 | $1,412.54 | $2,238.72 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $102.33 Typical High $165.96 | Professional | None | $97.72 | $102.33 | $165.96 |
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 $83.18 Median $109.65 Typical High $138.04 | Professional | None | $83.18 | $109.65 | $138.04 |
Martin's Point Setting Professional Modifier None Typical Low $74.13 Median $74.13 Typical High $74.13 | Professional | None | $74.13 | $74.13 | $74.13 |
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 $83.18 Median $112.20 Typical High $147.91 | Professional | None | $83.18 | $112.20 | $147.91 |
5 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 $37.15 Median $37.15 Typical High $37.15 | Professional | 52 · Reduced service | $37.15 | $37.15 | $37.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.79 Median $14.79 Typical High $14.79 | Professional | 53 · Discontinued | $14.79 | $14.79 | $14.79 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $54.95 Median $54.95 Typical High $54.95 | Professional | 54 · Surgery only | $54.95 | $54.95 | $54.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.96 Median $10.96 Typical High $10.96 | Professional | 55 · Aftercare only | $10.96 | $10.96 | $10.96 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.41 Median $7.41 Typical High $7.41 | Professional | 56 · Pre-op care only | $7.41 | $7.41 | $7.41 |
Where Maine sits
The same service costs 11.2 times more in Tennessee than in New York. 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· 37th of 51
$105
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.