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 $87.10 Median $87.10 Typical High $229.09 | Facility | None | $87.10 | $87.10 | $229.09 |
Aetna Setting Professional Modifier None Typical Low $64.57 Median $144.54 Typical High $229.09 | Professional | None | $64.57 | $144.54 | $229.09 |
Anthem BCBS Setting Professional Modifier None Typical Low $56.23 Median $93.33 Typical High $190.55 | Professional | None | $56.23 | $93.33 | $190.55 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $95.50 Median $138.04 Typical High $190.55 | Professional | 50 · Both sides | $95.50 | $138.04 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $93.33 Median $229.09 Typical High $363.08 | Professional | None | $93.33 | $229.09 | $363.08 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $69.18 Median $177.83 Typical High $354.81 | Professional | None | $69.18 | $177.83 | $354.81 |
Martin's Point Setting Professional Modifier None Typical Low $64.57 Median $144.54 Typical High $229.09 | Professional | None | $64.57 | $144.54 | $229.09 |
United Setting Professional Modifier None Typical Low $79.43 Median $169.82 Typical High $309.03 | Professional | None | $79.43 | $169.82 | $309.03 |
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 $34.67 Median $42.66 Typical High $114.82 | Professional | 52 · Reduced service | $34.67 | $42.66 | $114.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $13.80 Median $17.38 Typical High $45.71 | Professional | 53 · Discontinued | $13.80 | $17.38 | $45.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $52.48 Median $64.57 Typical High $169.82 | Professional | 54 · Surgery only | $52.48 | $64.57 | $169.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.47 Median $12.88 Typical High $34.67 | Professional | 55 · Aftercare only | $10.47 | $12.88 | $34.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.92 Median $8.71 Typical High $22.91 | Professional | 56 · Pre-op care only | $6.92 | $8.71 | $22.91 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $39.81 Median $42.66 Typical High $114.82 | Professional | 52 · Reduced service | $39.81 | $42.66 | $114.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $16.22 Median $17.38 Typical High $45.71 | Professional | 53 · Discontinued | $16.22 | $17.38 | $45.71 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $64.57 Median $64.57 Typical High $169.82 | Professional | 54 · Surgery only | $64.57 | $64.57 | $169.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $12.02 Median $12.88 Typical High $34.67 | Professional | 55 · Aftercare only | $12.02 | $12.88 | $34.67 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $7.94 Median $8.71 Typical High $22.91 | Professional | 56 · Pre-op care only | $7.94 | $8.71 | $22.91 |
Where Maine sits
The same service costs 3.5 times more in North Carolina than in Indiana. 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· 47th of 51
$120
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.