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 $60.26 Median $114.82 Typical High $177.83 | Professional | None | $60.26 | $114.82 | $177.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $58.88 Median $89.13 Typical High $131.83 | Professional | None | $58.88 | $89.13 | $131.83 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $87.10 Median $134.90 Typical High $186.21 | Professional | 50 · Both sides | $87.10 | $134.90 | $186.21 |
Cigna Setting Facility Modifier None Typical Low $128.82 Median $295.12 Typical High $2,290.87 | Facility | None | $128.82 | $295.12 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $81.28 Median $147.91 Typical High $275.42 | Professional | None | $81.28 | $147.91 | $275.42 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $72.44 Median $144.54 Typical High $275.42 | Professional | None | $72.44 | $144.54 | $275.42 |
Martin's Point Setting Professional Modifier None Typical Low $60.26 Median $114.82 Typical High $177.83 | Professional | None | $60.26 | $114.82 | $177.83 |
United Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
United Setting Professional Modifier None Typical Low $83.18 Median $141.25 Typical High $245.47 | Professional | None | $83.18 | $141.25 | $245.47 |
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 $30.20 Median $36.31 Typical High $69.18 | Professional | 52 · Reduced service | $30.20 | $36.31 | $69.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $14.45 Typical High $27.54 | Professional | 53 · Discontinued | $12.02 | $14.45 | $27.54 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $45.71 Median $54.95 Typical High $102.33 | Professional | 54 · Surgery only | $45.71 | $54.95 | $102.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.12 Median $10.96 Typical High $20.42 | Professional | 55 · Aftercare only | $9.12 | $10.96 | $20.42 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.03 Median $7.24 Typical High $13.80 | Professional | 56 · Pre-op care only | $6.03 | $7.24 | $13.80 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $30.20 Median $36.31 Typical High $69.18 | Professional | 52 · Reduced service | $30.20 | $36.31 | $69.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $12.02 Median $14.45 Typical High $27.54 | Professional | 53 · Discontinued | $12.02 | $14.45 | $27.54 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $45.71 Median $54.95 Typical High $102.33 | Professional | 54 · Surgery only | $45.71 | $54.95 | $102.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $9.12 Median $10.96 Typical High $20.42 | Professional | 55 · Aftercare only | $9.12 | $10.96 | $20.42 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.03 Median $7.24 Typical High $13.80 | Professional | 56 · Pre-op care only | $6.03 | $7.24 | $13.80 |
Where Maine sits
The same service costs 5.9 times more in Oklahoma 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· 47th of 51
$115
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.