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 $18.62 Median $24.55 Typical High $58.88 | Facility | None | $18.62 | $24.55 | $58.88 |
Aetna Setting Professional Modifier None Typical Low $18.62 Median $47.86 Typical High $131.83 | Professional | None | $18.62 | $47.86 | $131.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $22.39 Median $67.61 Typical High $134.90 | Professional | None | $22.39 | $67.61 | $134.90 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $24.55 Median $61.66 Typical High $158.49 | Professional | None | $24.55 | $61.66 | $158.49 |
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 $28.18 Median $60.26 Typical High $131.83 | Professional | None | $28.18 | $60.26 | $131.83 |
Martin's Point Setting Facility Modifier None Typical Low $18.62 Median $24.55 Typical High $97.72 | Facility | None | $18.62 | $24.55 | $97.72 |
Martin's Point Setting Professional Modifier None Typical Low $18.62 Median $50.12 Typical High $131.83 | Professional | None | $18.62 | $50.12 | $131.83 |
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 $30.90 Median $58.88 Typical High $112.20 | Professional | None | $30.90 | $58.88 | $112.20 |
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 $9.33 Median $12.88 Typical High $29.51 | Professional | 52 · Reduced service | $9.33 | $12.88 | $29.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.72 Median $5.13 Typical High $12.02 | Professional | 53 · Discontinued | $3.72 | $5.13 | $12.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $14.13 Median $19.05 Typical High $44.67 | Professional | 54 · Surgery only | $14.13 | $19.05 | $44.67 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.82 Median $3.80 Typical High $8.91 | Professional | 55 · Aftercare only | $2.82 | $3.80 | $8.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.86 Median $2.51 Typical High $5.89 | Professional | 56 · Pre-op care only | $1.86 | $2.51 | $5.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $9.33 Median $10.96 Typical High $29.51 | Professional | 52 · Reduced service | $9.33 | $10.96 | $29.51 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $3.72 Median $4.47 Typical High $12.02 | Professional | 53 · Discontinued | $3.72 | $4.47 | $12.02 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $14.13 Median $16.60 Typical High $44.67 | Professional | 54 · Surgery only | $14.13 | $16.60 | $44.67 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.82 Median $3.31 Typical High $8.91 | Professional | 55 · Aftercare only | $2.82 | $3.31 | $8.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.86 Median $2.19 Typical High $5.89 | Professional | 56 · Pre-op care only | $1.86 | $2.19 | $5.89 |
Where Maine sits
The same service costs 3.4 times more in Wisconsin 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· 39th of 51
$58.88
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.