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 $66.07 Median $114.82 Typical High $199.53 | Professional | None | $66.07 | $114.82 | $199.53 |
Anthem BCBS Setting Professional Modifier None Typical Low $52.48 Median $75.86 Typical High $114.82 | Professional | None | $52.48 | $75.86 | $114.82 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $79.43 Median $114.82 Typical High $154.88 | Professional | 50 · Both sides | $79.43 | $114.82 | $154.88 |
Cigna Setting Facility Modifier None Typical Low $97.72 Median $223.87 Typical High $1,412.54 | Facility | None | $97.72 | $223.87 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $67.61 Median $125.89 Typical High $204.17 | Professional | None | $67.61 | $125.89 | $204.17 |
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 $61.66 Median $125.89 Typical High $223.87 | Professional | None | $61.66 | $125.89 | $223.87 |
Martin's Point Setting Professional Modifier None Typical Low $66.07 Median $128.82 Typical High $199.53 | Professional | None | $66.07 | $128.82 | $199.53 |
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 $56.23 Median $125.89 Typical High $204.17 | Professional | None | $56.23 | $125.89 | $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 $32.36 Median $47.86 Typical High $66.07 | Professional | 52 · Reduced service | $32.36 | $47.86 | $66.07 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $19.05 Typical High $26.30 | Professional | 53 · Discontinued | $13.18 | $19.05 | $26.30 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $48.98 Median $72.44 Typical High $100.00 | Professional | 54 · Surgery only | $48.98 | $72.44 | $100.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $14.45 Typical High $19.95 | Professional | 55 · Aftercare only | $9.77 | $14.45 | $19.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $9.55 Typical High $13.18 | Professional | 56 · Pre-op care only | $6.61 | $9.55 | $13.18 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $32.36 Median $45.71 Typical High $66.07 | Professional | 52 · Reduced service | $32.36 | $45.71 | $66.07 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $13.18 Median $18.62 Typical High $26.30 | Professional | 53 · Discontinued | $13.18 | $18.62 | $26.30 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $48.98 Median $69.18 Typical High $100.00 | Professional | 54 · Surgery only | $48.98 | $69.18 | $100.00 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $13.80 Typical High $19.95 | Professional | 55 · Aftercare only | $9.77 | $13.80 | $19.95 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.61 Median $9.33 Typical High $13.18 | Professional | 56 · Pre-op care only | $6.61 | $9.33 | $13.18 |
Where Maine sits
The same service costs 3.2 times more in Alaska than in Virginia. 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· 45th of 51
$102
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.