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 $67.61 Median $95.50 Typical High $151.36 | Professional | None | $67.61 | $95.50 | $151.36 |
Anthem BCBS Setting Professional Modifier None Typical Low $51.29 Median $75.86 Typical High $104.71 | Professional | None | $51.29 | $75.86 | $104.71 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $79.43 Median $104.71 Typical High $158.49 | Professional | 50 · Both sides | $79.43 | $104.71 | $158.49 |
Cigna Setting Facility Modifier None Typical Low $57.54 Median $131.83 Typical High $1,412.54 | Facility | None | $57.54 | $131.83 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $69.18 Median $109.65 Typical High $165.96 | Professional | None | $69.18 | $109.65 | $165.96 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $58.88 Median $107.15 Typical High $186.21 | Professional | None | $58.88 | $107.15 | $186.21 |
Martin's Point Setting Professional Modifier None Typical Low $67.61 Median $95.50 Typical High $147.91 | Professional | None | $67.61 | $95.50 | $147.91 |
United Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
United Setting Professional Modifier None Typical Low $57.54 Median $104.71 Typical High $199.53 | Professional | None | $57.54 | $104.71 | $199.53 |
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 $33.88 Median $38.02 Typical High $50.12 | Professional | 52 · Reduced service | $33.88 | $38.02 | $50.12 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.49 Median $15.14 Typical High $19.95 | Professional | 53 · Discontinued | $13.49 | $15.14 | $19.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $50.12 Median $56.23 Typical High $74.13 | Professional | 54 · Surgery only | $50.12 | $56.23 | $74.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $11.22 Typical High $14.79 | Professional | 55 · Aftercare only | $10.00 | $11.22 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.76 Median $7.59 Typical High $10.00 | Professional | 56 · Pre-op care only | $6.76 | $7.59 | $10.00 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $33.88 Median $36.31 Typical High $50.12 | Professional | 52 · Reduced service | $33.88 | $36.31 | $50.12 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $13.49 Median $14.79 Typical High $19.95 | Professional | 53 · Discontinued | $13.49 | $14.79 | $19.95 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $50.12 Median $54.95 Typical High $74.13 | Professional | 54 · Surgery only | $50.12 | $54.95 | $74.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $10.00 Median $10.96 Typical High $14.79 | Professional | 55 · Aftercare only | $10.00 | $10.96 | $14.79 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.76 Median $7.41 Typical High $10.00 | Professional | 56 · Pre-op care only | $6.76 | $7.41 | $10.00 |
Where Maine sits
The same service costs 3.2 times more in Alaska 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.
Maine· 31st of 51
$95.50
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.