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 $22.39 Median $27.54 Typical High $40.74 | Facility | None | $22.39 | $27.54 | $40.74 |
Aetna Setting Professional Modifier None Typical Low $22.39 Median $36.31 Typical High $74.13 | Professional | None | $22.39 | $36.31 | $74.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $22.91 Median $44.67 Typical High $85.11 | Professional | None | $22.91 | $44.67 | $85.11 |
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 $26.92 Median $50.12 Typical High $87.10 | Professional | None | $26.92 | $50.12 | $87.10 |
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 $30.90 Median $46.77 Typical High $85.11 | Professional | None | $30.90 | $46.77 | $85.11 |
Martin's Point Setting Facility Modifier None Typical Low $22.39 Median $27.54 Typical High $56.23 | Facility | None | $22.39 | $27.54 | $56.23 |
Martin's Point Setting Professional Modifier None Typical Low $22.39 Median $38.90 Typical High $74.13 | Professional | None | $22.39 | $38.90 | $74.13 |
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 $33.11 Median $46.77 Typical High $81.28 | Professional | None | $33.11 | $46.77 | $81.28 |
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 $11.22 Median $11.48 Typical High $20.42 | Professional | 52 · Reduced service | $11.22 | $11.48 | $20.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.47 Median $4.57 Typical High $8.13 | Professional | 53 · Discontinued | $4.47 | $4.57 | $8.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $16.98 Median $16.98 Typical High $30.90 | Professional | 54 · Surgery only | $16.98 | $16.98 | $30.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.39 Median $3.47 Typical High $6.17 | Professional | 55 · Aftercare only | $3.39 | $3.47 | $6.17 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.24 Median $2.29 Typical High $4.07 | Professional | 56 · Pre-op care only | $2.24 | $2.29 | $4.07 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $11.22 Median $11.22 Typical High $20.42 | Professional | 52 · Reduced service | $11.22 | $11.22 | $20.42 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $4.47 Median $4.47 Typical High $8.13 | Professional | 53 · Discontinued | $4.47 | $4.47 | $8.13 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $16.98 Median $16.98 Typical High $30.90 | Professional | 54 · Surgery only | $16.98 | $16.98 | $30.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.39 Median $3.39 Typical High $6.17 | Professional | 55 · Aftercare only | $3.39 | $3.39 | $6.17 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.24 Median $2.24 Typical High $4.07 | Professional | 56 · Pre-op care only | $2.24 | $2.24 | $4.07 |
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· 43rd of 51
$40.74
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.