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 Facility Modifier None Typical Low $22.91 Median $22.91 Typical High $45.71 | Facility | None | $22.91 | $22.91 | $45.71 |
Aetna Setting Professional Modifier None Typical Low $22.91 Median $45.71 Typical High $74.13 | Professional | None | $22.91 | $45.71 | $74.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $25.70 Median $52.48 Typical High $109.65 | Professional | None | $25.70 | $52.48 | $109.65 |
Cigna Setting Facility Modifier None Typical Low $43.65 Median $61.66 Typical High $707.95 | Facility | None | $43.65 | $61.66 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $30.90 Median $64.57 Typical High $114.82 | Professional | None | $30.90 | $64.57 | $114.82 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $34.67 Median $54.95 Typical High $97.72 | Professional | None | $34.67 | $54.95 | $97.72 |
Martin's Point Setting Professional Modifier None Typical Low $22.91 Median $45.71 Typical High $81.28 | Professional | None | $22.91 | $45.71 | $81.28 |
United Setting Facility Modifier None Typical Low $338.84 Median $524.81 Typical High $707.95 | Facility | None | $338.84 | $524.81 | $707.95 |
United Setting Professional Modifier None Typical Low $38.02 Median $54.95 Typical High $95.50 | Professional | None | $38.02 | $54.95 | $95.50 |
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 $11.48 Median $13.49 Typical High $22.91 | Professional | 52 · Reduced service | $11.48 | $13.49 | $22.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.57 Median $5.37 Typical High $9.12 | Professional | 53 · Discontinued | $4.57 | $5.37 | $9.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $16.98 Median $19.95 Typical High $33.88 | Professional | 54 · Surgery only | $16.98 | $19.95 | $33.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.39 Median $4.07 Typical High $6.76 | Professional | 55 · Aftercare only | $3.39 | $4.07 | $6.76 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.29 Median $2.69 Typical High $4.57 | Professional | 56 · Pre-op care only | $2.29 | $2.69 | $4.57 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $11.48 Median $13.49 Typical High $22.91 | Professional | 52 · Reduced service | $11.48 | $13.49 | $22.91 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $4.57 Median $5.37 Typical High $9.12 | Professional | 53 · Discontinued | $4.57 | $5.37 | $9.12 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $16.98 Median $19.95 Typical High $33.88 | Professional | 54 · Surgery only | $16.98 | $19.95 | $33.88 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.39 Median $4.07 Typical High $6.76 | Professional | 55 · Aftercare only | $3.39 | $4.07 | $6.76 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.29 Median $2.69 Typical High $4.57 | Professional | 56 · Pre-op care only | $2.29 | $2.69 | $4.57 |
Where Maine sits
The same service costs 3.3 times more in Alaska than in New Jersey. 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· 41st of 51
$51.29
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.