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 Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $323.59 | Professional | None | $165.96 | $165.96 | $323.59 |
Anthem BCBS Setting Professional Modifier None Typical Low $131.83 Median $257.04 Typical High $512.86 | Professional | None | $131.83 | $257.04 | $512.86 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $213.80 Median $389.05 Typical High $794.33 | Professional | 50 · Both sides | $213.80 | $389.05 | $794.33 |
Cigna Setting Facility Modifier None Typical Low $245.47 Median $562.34 Typical High $1,862.09 | Facility | None | $245.47 | $562.34 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $316.23 Typical High $524.81 | Professional | None | $173.78 | $316.23 | $524.81 |
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 $147.91 Median $269.15 Typical High $512.86 | Professional | None | $147.91 | $269.15 | $512.86 |
Martin's Point Setting Professional Modifier None Typical Low $165.96 Median $165.96 Typical High $323.59 | Professional | None | $165.96 | $165.96 | $323.59 |
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 $177.83 Median $269.15 Typical High $467.74 | Professional | None | $177.83 | $269.15 | $467.74 |
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 $83.18 Median $83.18 Typical High $162.18 | Professional | 52 · Reduced service | $83.18 | $83.18 | $162.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $33.11 Median $33.11 Typical High $64.57 | Professional | 53 · Discontinued | $33.11 | $33.11 | $64.57 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $123.03 Typical High $245.47 | Professional | 54 · Surgery only | $123.03 | $123.03 | $245.47 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $24.55 Typical High $48.98 | Professional | 55 · Aftercare only | $24.55 | $24.55 | $48.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $16.60 Median $16.60 Typical High $32.36 | Professional | 56 · Pre-op care only | $16.60 | $16.60 | $32.36 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $83.18 Median $83.18 Typical High $162.18 | Professional | 52 · Reduced service | $83.18 | $83.18 | $162.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $33.11 Median $33.11 Typical High $64.57 | Professional | 53 · Discontinued | $33.11 | $33.11 | $64.57 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $123.03 Median $123.03 Typical High $245.47 | Professional | 54 · Surgery only | $123.03 | $123.03 | $245.47 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $24.55 Median $24.55 Typical High $48.98 | Professional | 55 · Aftercare only | $24.55 | $24.55 | $48.98 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $16.60 Median $16.60 Typical High $32.36 | Professional | 56 · Pre-op care only | $16.60 | $16.60 | $32.36 |
Where Maine sits
The same service costs 3.2 times more in Wisconsin than in Kentucky. 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· 35th of 51
$269
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.