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 $13.80 Median $13.80 Typical High $42.66 | Facility | None | $13.80 | $13.80 | $42.66 |
Aetna Setting Professional Modifier None Typical Low $10.23 Median $23.44 Typical High $42.66 | Professional | None | $10.23 | $23.44 | $42.66 |
Anthem BCBS Setting Professional Modifier None Typical Low $8.71 Median $23.44 Typical High $56.23 | Professional | None | $8.71 | $23.44 | $56.23 |
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 $11.75 Median $33.11 Typical High $60.26 | Professional | None | $11.75 | $33.11 | $60.26 |
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 $11.48 Median $17.78 Typical High $60.26 | Professional | None | $11.48 | $17.78 | $60.26 |
Martin's Point Setting Professional Modifier None Typical Low $10.00 Median $22.39 Typical High $42.66 | Professional | None | $10.00 | $22.39 | $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 $12.30 Median $17.78 Typical High $42.66 | Professional | None | $12.30 | $17.78 | $42.66 |
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 $6.92 Median $6.92 Typical High $21.38 | Professional | 52 · Reduced service | $6.92 | $6.92 | $21.38 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.75 Median $2.75 Typical High $8.51 | Professional | 53 · Discontinued | $2.75 | $2.75 | $8.51 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.47 Median $10.47 Typical High $32.36 | Professional | 54 · Surgery only | $10.47 | $10.47 | $32.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.09 Median $2.09 Typical High $6.46 | Professional | 55 · Aftercare only | $2.09 | $2.09 | $6.46 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.38 Median $1.38 Typical High $4.27 | Professional | 56 · Pre-op care only | $1.38 | $1.38 | $4.27 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $6.92 Median $6.92 Typical High $21.38 | Professional | 52 · Reduced service | $6.92 | $6.92 | $21.38 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.75 Median $2.75 Typical High $8.51 | Professional | 53 · Discontinued | $2.75 | $2.75 | $8.51 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $10.47 Median $10.47 Typical High $32.36 | Professional | 54 · Surgery only | $10.47 | $10.47 | $32.36 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.09 Median $2.09 Typical High $6.46 | Professional | 55 · Aftercare only | $2.09 | $2.09 | $6.46 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.38 Median $1.38 Typical High $4.27 | Professional | 56 · Pre-op care only | $1.38 | $1.38 | $4.27 |
Where Maine sits
The same service costs 4.2 times more in Wisconsin than in Nebraska. 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· 44th of 51
$26.92
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.