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 $131.83 Median $177.83 Typical High $199.53 | Professional | None | $131.83 | $177.83 | $199.53 |
Anthem BCBS Setting Professional Modifier None Typical Low $109.65 Median $147.91 Typical High $223.87 | Professional | None | $109.65 | $147.91 | $223.87 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $154.88 Typical High $707.95 | Facility | None | $56.23 | $154.88 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $141.25 Median $199.53 Typical High $263.03 | Professional | None | $141.25 | $199.53 | $263.03 |
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 $186.21 Typical High $323.59 | Professional | None | $128.82 | $186.21 | $323.59 |
Martin's Point Setting Professional Modifier None Typical Low $131.83 Median $177.83 Typical High $199.53 | Professional | None | $131.83 | $177.83 | $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 $114.82 Median $162.18 Typical High $251.19 | Professional | None | $114.82 | $162.18 | $251.19 |
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 $66.07 Median $66.07 Typical High $89.13 | Professional | 52 · Reduced service | $66.07 | $66.07 | $89.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $26.92 Typical High $35.48 | Professional | 53 · Discontinued | $26.92 | $26.92 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $100.00 Typical High $134.90 | Professional | 54 · Surgery only | $100.00 | $100.00 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $19.95 Typical High $26.92 | Professional | 55 · Aftercare only | $19.95 | $19.95 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $13.18 Typical High $17.78 | Professional | 56 · Pre-op care only | $13.18 | $13.18 | $17.78 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $66.07 Median $66.07 Typical High $89.13 | Professional | 52 · Reduced service | $66.07 | $66.07 | $89.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $26.92 Typical High $35.48 | Professional | 53 · Discontinued | $26.92 | $26.92 | $35.48 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $100.00 Typical High $134.90 | Professional | 54 · Surgery only | $100.00 | $100.00 | $134.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $19.95 Typical High $26.92 | Professional | 55 · Aftercare only | $19.95 | $19.95 | $26.92 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $13.18 Median $13.18 Typical High $17.78 | Professional | 56 · Pre-op care only | $13.18 | $13.18 | $17.78 |
Where Maine sits
The same service costs 3.5 times more in Alaska than in Florida. 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· 32nd of 51
$174
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.