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 $120.23 Median $208.93 Typical High $363.08 | Professional | None | $120.23 | $208.93 | $363.08 |
Anthem BCBS Setting Professional Modifier None Typical Low $134.90 Median $229.09 Typical High $426.58 | Professional | None | $134.90 | $229.09 | $426.58 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $190.55 Median $354.81 Typical High $660.69 | Professional | 50 · Both sides | $190.55 | $354.81 | $660.69 |
Cigna Setting Facility Modifier None Typical Low $169.82 Median $380.19 Typical High $3,235.94 | Facility | None | $169.82 | $380.19 | $3,235.94 |
Cigna Setting Professional Modifier None Typical Low $162.18 Median $288.40 Typical High $512.86 | Professional | None | $162.18 | $288.40 | $512.86 |
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 $134.90 Median $245.47 Typical High $426.58 | Professional | None | $134.90 | $245.47 | $426.58 |
Martin's Point Setting Professional Modifier None Typical Low $120.23 Median $208.93 Typical High $363.08 | Professional | None | $120.23 | $208.93 | $363.08 |
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 $165.96 Median $245.47 Typical High $407.38 | Professional | None | $165.96 | $245.47 | $407.38 |
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 $60.26 Median $102.33 Typical High $102.33 | Professional | 52 · Reduced service | $60.26 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $41.69 Typical High $41.69 | Professional | 53 · Discontinued | $23.99 | $41.69 | $41.69 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $154.88 Typical High $154.88 | Professional | 54 · Surgery only | $89.13 | $154.88 | $154.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.78 Median $30.90 Typical High $30.90 | Professional | 55 · Aftercare only | $17.78 | $30.90 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $20.89 Typical High $20.89 | Professional | 56 · Pre-op care only | $12.02 | $20.89 | $20.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $60.26 Median $102.33 Typical High $102.33 | Professional | 52 · Reduced service | $60.26 | $102.33 | $102.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $23.99 Median $41.69 Typical High $41.69 | Professional | 53 · Discontinued | $23.99 | $41.69 | $41.69 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $89.13 Median $154.88 Typical High $154.88 | Professional | 54 · Surgery only | $89.13 | $154.88 | $154.88 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $17.78 Median $30.90 Typical High $30.90 | Professional | 55 · Aftercare only | $17.78 | $30.90 | $30.90 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.02 Median $20.89 Typical High $20.89 | Professional | 56 · Pre-op care only | $12.02 | $20.89 | $20.89 |
Where Maine sits
The same service costs 3.2 times more in Oklahoma than in Texas. 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· 49th of 51
$214
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.