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 Facility Modifier None Typical Low $79.43 Median $1,819.70 Typical High $9,772.37 | Facility | None | $79.43 | $1,819.70 | $9,772.37 |
Aetna Setting Professional Modifier None Typical Low $81.28 Median $144.54 Typical High $263.03 | Professional | None | $81.28 | $144.54 | $263.03 |
Ambetter Setting Professional Modifier None Typical Low $151.36 Median $151.36 Typical High $151.36 | Professional | None | $151.36 | $151.36 | $151.36 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,288.25 Median $1,548.82 Typical High $3,467.37 | Facility | None | $1,288.25 | $1,548.82 | $3,467.37 |
Anthem BCBS Setting Professional Modifier None Typical Low $69.18 Median $151.36 Typical High $234.42 | Professional | None | $69.18 | $151.36 | $234.42 |
Cigna Setting Facility Modifier None Typical Low $162.18 Median $213.80 Typical High $575.44 | Facility | None | $162.18 | $213.80 | $575.44 |
Cigna Setting Professional Modifier None Typical Low $117.49 Median $218.78 Typical High $380.19 | Professional | None | $117.49 | $218.78 | $380.19 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $660.69 Median $776.25 Typical High $2,691.53 | Facility | None | $660.69 | $776.25 | $2,691.53 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $87.10 Median $194.98 Typical High $467.74 | Professional | None | $87.10 | $194.98 | $467.74 |
United Setting Facility Modifier None Typical Low $660.69 Median $851.14 Typical High $2,691.53 | Facility | None | $660.69 | $851.14 | $2,691.53 |
United Setting Professional Modifier None Typical Low $100.00 Median $177.83 Typical High $346.74 | Professional | None | $100.00 | $177.83 | $346.74 |
Well Sense Setting Facility Modifier None Typical Low $83.18 Median $83.18 Typical High $83.18 | Facility | None | $83.18 | $83.18 | $83.18 |
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 $40.74 Median $67.61 Typical High $72.44 | Professional | 52 · Reduced service | $40.74 | $67.61 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.22 Median $26.92 Typical High $28.84 | Professional | 53 · Discontinued | $16.22 | $26.92 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $102.33 Typical High $107.15 | Professional | 54 · Surgery only | $61.66 | $102.33 | $107.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $20.42 Typical High $21.88 | Professional | 55 · Aftercare only | $12.30 | $20.42 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.13 Median $13.49 Typical High $14.45 | Professional | 56 · Pre-op care only | $8.13 | $13.49 | $14.45 |
Where New Hampshire sits
The same service costs 3.3 times more in Wisconsin than in Kentucky. 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.
New Hampshire· 27th of 51
$155
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.