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 $48.98 Median $48.98 Typical High $112.20 | Facility | None | $48.98 | $48.98 | $112.20 |
Aetna Setting Professional Modifier None Typical Low $48.98 Median $95.50 Typical High $213.80 | Professional | None | $48.98 | $95.50 | $213.80 |
Anthem BCBS Setting Professional Modifier None Typical Low $60.26 Median $112.20 Typical High $245.47 | Professional | None | $60.26 | $112.20 | $245.47 |
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 $66.07 Median $138.04 Typical High $263.03 | Professional | None | $66.07 | $138.04 | $263.03 |
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 $67.61 Median $134.90 Typical High $245.47 | Professional | None | $67.61 | $134.90 | $245.47 |
Martin's Point Setting Professional Modifier None Typical Low $48.98 Median $95.50 Typical High $213.80 | Professional | None | $48.98 | $95.50 | $213.80 |
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 $81.28 Median $117.49 Typical High $234.42 | Professional | None | $81.28 | $117.49 | $234.42 |
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 $24.55 Median $30.20 Typical High $56.23 | Professional | 52 · Reduced service | $24.55 | $30.20 | $56.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.77 Median $12.02 Typical High $22.39 | Professional | 53 · Discontinued | $9.77 | $12.02 | $22.39 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $37.15 Median $45.71 Typical High $85.11 | Professional | 54 · Surgery only | $37.15 | $45.71 | $85.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.41 Median $9.12 Typical High $16.98 | Professional | 55 · Aftercare only | $7.41 | $9.12 | $16.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.90 Median $6.03 Typical High $11.22 | Professional | 56 · Pre-op care only | $4.90 | $6.03 | $11.22 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $24.55 Median $30.20 Typical High $56.23 | Professional | 52 · Reduced service | $24.55 | $30.20 | $56.23 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $9.77 Median $12.02 Typical High $22.39 | Professional | 53 · Discontinued | $9.77 | $12.02 | $22.39 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $37.15 Median $45.71 Typical High $85.11 | Professional | 54 · Surgery only | $37.15 | $45.71 | $85.11 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.41 Median $9.12 Typical High $16.98 | Professional | 55 · Aftercare only | $7.41 | $9.12 | $16.98 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.90 Median $6.03 Typical High $11.22 | Professional | 56 · Pre-op care only | $4.90 | $6.03 | $11.22 |
Where Maine sits
The same service costs 3.5 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· 35th of 51
$112
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.