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 $20.42 Median $20.42 Typical High $26.92 | Facility | None | $20.42 | $20.42 | $26.92 |
Aetna Setting Professional Modifier None Typical Low $20.42 Median $26.92 Typical High $42.66 | Professional | None | $20.42 | $26.92 | $42.66 |
Anthem BCBS Setting Professional Modifier None Typical Low $24.55 Median $37.15 Typical High $61.66 | Professional | None | $24.55 | $37.15 | $61.66 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $707.95 Typical High $2,290.87 | Facility | None | $691.83 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $28.18 Median $36.31 Typical High $69.18 | Professional | None | $28.18 | $36.31 | $69.18 |
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 $31.62 Median $42.66 Typical High $64.57 | Professional | None | $31.62 | $42.66 | $64.57 |
Martin's Point Setting Professional Modifier None Typical Low $20.42 Median $26.92 Typical High $42.66 | Professional | None | $20.42 | $26.92 | $42.66 |
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 $44.67 Typical High $61.66 | Professional | None | $33.11 | $44.67 | $61.66 |
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 $10.23 Median $12.30 Typical High $13.49 | Professional | 52 · Reduced service | $10.23 | $12.30 | $13.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.07 Median $4.90 Typical High $5.50 | Professional | 53 · Discontinued | $4.07 | $4.90 | $5.50 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $15.49 Median $18.62 Typical High $20.42 | Professional | 54 · Surgery only | $15.49 | $18.62 | $20.42 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.09 Median $3.72 Typical High $4.07 | Professional | 55 · Aftercare only | $3.09 | $3.72 | $4.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.04 Median $2.45 Typical High $2.69 | Professional | 56 · Pre-op care only | $2.04 | $2.45 | $2.69 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $10.23 Median $12.30 Typical High $13.49 | Professional | 52 · Reduced service | $10.23 | $12.30 | $13.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $4.07 Median $4.90 Typical High $5.50 | Professional | 53 · Discontinued | $4.07 | $4.90 | $5.50 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $15.49 Median $18.62 Typical High $20.42 | Professional | 54 · Surgery only | $15.49 | $18.62 | $20.42 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.09 Median $3.72 Typical High $4.07 | Professional | 55 · Aftercare only | $3.09 | $3.72 | $4.07 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.04 Median $2.45 Typical High $2.69 | Professional | 56 · Pre-op care only | $2.04 | $2.45 | $2.69 |
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· 28th of 51
$37.15
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.