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 $234.42 Median $912.01 Typical High $2,041.74 | Professional | None | $234.42 | $912.01 | $2,041.74 |
Anthem BCBS Setting Professional Modifier None Typical Low $275.42 Median $954.99 Typical High $2,454.71 | Professional | None | $275.42 | $954.99 | $2,454.71 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $426.58 Median $1,445.44 Typical High $3,715.35 | Professional | 50 · Both sides | $426.58 | $1,445.44 | $3,715.35 |
Cigna Setting Professional Modifier None Typical Low $302.00 Median $1,318.26 Typical High $2,511.89 | Professional | None | $302.00 | $1,318.26 | $2,511.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $275.42 Median $1,148.15 Typical High $2,818.38 | Professional | None | $275.42 | $1,148.15 | $2,818.38 |
Martin's Point Setting Professional Modifier None Typical Low $234.42 Median $912.01 Typical High $2,041.74 | Professional | None | $234.42 | $912.01 | $2,041.74 |
United Setting Professional Modifier None Typical Low $295.12 Median $812.83 Typical High $2,344.23 | Professional | None | $295.12 | $812.83 | $2,344.23 |
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 $141.25 Median $177.83 Typical High $1,000.00 | Professional | 52 · Reduced service | $141.25 | $177.83 | $1,000.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $72.44 Typical High $407.38 | Professional | 53 · Discontinued | $56.23 | $72.44 | $407.38 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $208.93 Median $269.15 Typical High $1,513.56 | Professional | 54 · Surgery only | $208.93 | $269.15 | $1,513.56 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $42.66 Median $53.70 Typical High $302.00 | Professional | 55 · Aftercare only | $42.66 | $53.70 | $302.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $35.48 Typical High $204.17 | Professional | 56 · Pre-op care only | $28.18 | $35.48 | $204.17 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $162.18 Median $177.83 Typical High $1,000.00 | Professional | 52 · Reduced service | $162.18 | $177.83 | $1,000.00 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $64.57 Median $72.44 Typical High $407.38 | Professional | 53 · Discontinued | $64.57 | $72.44 | $407.38 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $269.15 Median $269.15 Typical High $1,513.56 | Professional | 54 · Surgery only | $269.15 | $269.15 | $1,513.56 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $47.86 Median $53.70 Typical High $302.00 | Professional | 55 · Aftercare only | $47.86 | $53.70 | $302.00 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $32.36 Median $35.48 Typical High $204.17 | Professional | 56 · Pre-op care only | $32.36 | $35.48 | $204.17 |
Where Maine sits
The same service costs 6.5 times more in Washington than in Maryland. 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· 39th of 51
$1,023
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.