How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 Professional Modifier None Typical Low $61.66 Median $134.90 Typical High $151.36 | Professional | None | $61.66 | $134.90 | $151.36 |
Anthem BCBS Setting Professional Modifier None Typical Low $79.43 Median $151.36 Typical High $302.00 | Professional | None | $79.43 | $151.36 | $302.00 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $125.89 Median $218.78 Typical High $457.09 | Professional | 50 · Both sides | $125.89 | $218.78 | $457.09 |
Cigna Setting Professional Modifier None Typical Low $107.15 Median $213.80 Typical High $331.13 | Professional | None | $107.15 | $213.80 | $331.13 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $79.43 Median $173.78 Typical High $302.00 | Professional | None | $79.43 | $173.78 | $302.00 |
Martin's Point Setting Professional Modifier None Typical Low $61.66 Median $134.90 Typical High $151.36 | Professional | None | $61.66 | $134.90 | $151.36 |
United Setting Professional Modifier None Typical Low $93.33 Median $173.78 Typical High $288.40 | Professional | None | $93.33 | $173.78 | $288.40 |
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 $30.90 Median $44.67 Typical High $70.79 | Professional | 52 · Reduced service | $30.90 | $44.67 | $70.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.30 Median $18.20 Typical High $28.18 | Professional | 53 · Discontinued | $12.30 | $18.20 | $28.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $46.77 Median $67.61 Typical High $104.71 | Professional | 54 · Surgery only | $46.77 | $67.61 | $104.71 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.33 Median $13.49 Typical High $20.89 | Professional | 55 · Aftercare only | $9.33 | $13.49 | $20.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.17 Median $9.12 Typical High $14.13 | Professional | 56 · Pre-op care only | $6.17 | $9.12 | $14.13 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $30.90 Median $37.15 Typical High $67.61 | Professional | 52 · Reduced service | $30.90 | $37.15 | $67.61 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $12.30 Median $15.14 Typical High $26.92 | Professional | 53 · Discontinued | $12.30 | $15.14 | $26.92 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $46.77 Median $56.23 Typical High $102.33 | Professional | 54 · Surgery only | $46.77 | $56.23 | $102.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $9.33 Median $11.22 Typical High $20.42 | Professional | 55 · Aftercare only | $9.33 | $11.22 | $20.42 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.17 Median $7.59 Typical High $13.49 | Professional | 56 · Pre-op care only | $6.17 | $7.59 | $13.49 |
Where Maine sits
The same service costs 2.6 times more in Wisconsin than in Utah. 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
$141
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.