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 $134.90 Median $199.53 Typical High $309.03 | Professional | None | $134.90 | $199.53 | $309.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $109.65 Median $162.18 Typical High $218.78 | Professional | None | $109.65 | $162.18 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $194.98 Typical High $707.95 | Facility | None | $56.23 | $194.98 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $144.54 Median $218.78 Typical High $281.84 | Professional | None | $144.54 | $218.78 | $281.84 |
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 $128.82 Median $194.98 Typical High $354.81 | Professional | None | $128.82 | $194.98 | $354.81 |
Martin's Point Setting Professional Modifier None Typical Low $134.90 Median $199.53 Typical High $309.03 | Professional | None | $134.90 | $199.53 | $309.03 |
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 $117.49 Median $173.78 Typical High $269.15 | Professional | None | $117.49 | $173.78 | $269.15 |
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 $67.61 Median $70.79 Typical High $100.00 | Professional | 52 · Reduced service | $67.61 | $70.79 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $28.18 Typical High $39.81 | Professional | 53 · Discontinued | $26.92 | $28.18 | $39.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $107.15 Typical High $151.36 | Professional | 54 · Surgery only | $102.33 | $107.15 | $151.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $21.38 Typical High $30.20 | Professional | 55 · Aftercare only | $20.42 | $21.38 | $30.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.49 Median $14.13 Typical High $19.95 | Professional | 56 · Pre-op care only | $13.49 | $14.13 | $19.95 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $67.61 Median $67.61 Typical High $100.00 | Professional | 52 · Reduced service | $67.61 | $67.61 | $100.00 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $26.92 Typical High $39.81 | Professional | 53 · Discontinued | $26.92 | $26.92 | $39.81 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $102.33 Median $102.33 Typical High $151.36 | Professional | 54 · Surgery only | $102.33 | $102.33 | $151.36 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $20.42 Median $20.42 Typical High $30.20 | Professional | 55 · Aftercare only | $20.42 | $20.42 | $30.20 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $13.49 Median $13.49 Typical High $19.95 | Professional | 56 · Pre-op care only | $13.49 | $13.49 | $19.95 |
Where Maine sits
The same service costs 3.3 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· 31st of 51
$182
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.