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 $81.28 Median $144.54 Typical High $371.54 | Professional | None | $81.28 | $144.54 | $371.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $69.18 Median $114.82 Typical High $331.13 | Professional | None | $69.18 | $114.82 | $331.13 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $117.49 Median $173.78 Typical High $257.04 | Professional | 50 · Both sides | $117.49 | $173.78 | $257.04 |
Cigna Setting Professional Modifier None Typical Low $112.20 Median $302.00 Typical High $588.84 | Professional | None | $112.20 | $302.00 | $588.84 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $87.10 Median $275.42 Typical High $616.60 | Professional | None | $87.10 | $275.42 | $616.60 |
Martin's Point Setting Professional Modifier None Typical Low $79.43 Median $144.54 Typical High $398.11 | Professional | None | $79.43 | $144.54 | $398.11 |
United Setting Professional Modifier None Typical Low $93.33 Median $257.04 Typical High $501.19 | Professional | None | $93.33 | $257.04 | $501.19 |
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 $42.66 Median $53.70 Typical High $186.21 | Professional | 52 · Reduced service | $42.66 | $53.70 | $186.21 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $21.38 Typical High $74.13 | Professional | 53 · Discontinued | $17.38 | $21.38 | $74.13 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $64.57 Median $79.43 Typical High $281.84 | Professional | 54 · Surgery only | $64.57 | $79.43 | $281.84 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $15.85 Typical High $56.23 | Professional | 55 · Aftercare only | $12.88 | $15.85 | $56.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $10.72 Typical High $37.15 | Professional | 56 · Pre-op care only | $8.71 | $10.72 | $37.15 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $47.86 Median $53.70 Typical High $186.21 | Professional | 52 · Reduced service | $47.86 | $53.70 | $186.21 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $21.38 Typical High $74.13 | Professional | 53 · Discontinued | $19.05 | $21.38 | $74.13 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $79.43 Median $79.43 Typical High $281.84 | Professional | 54 · Surgery only | $79.43 | $79.43 | $281.84 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $14.45 Median $15.85 Typical High $56.23 | Professional | 55 · Aftercare only | $14.45 | $15.85 | $56.23 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $10.72 Typical High $37.15 | Professional | 56 · Pre-op care only | $9.55 | $10.72 | $37.15 |
Where Maine sits
The same service costs 4.2 times more in Washington than in Virginia. 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· 48th of 51
$145
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.