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 $70.79 Median $77.62 Typical High $186.21 | Professional | None | $70.79 | $77.62 | $186.21 |
Anthem BCBS Setting Professional Modifier None Typical Low $58.88 Median $151.36 Typical High $281.84 | Professional | None | $58.88 | $151.36 | $281.84 |
Cigna Setting Professional Modifier None Typical Low $79.43 Median $190.55 Typical High $338.84 | Professional | None | $79.43 | $190.55 | $338.84 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $64.57 Median $158.49 Typical High $281.84 | Professional | None | $64.57 | $158.49 | $281.84 |
Martin's Point Setting Professional Modifier None Typical Low $70.79 Median $77.62 Typical High $186.21 | Professional | None | $70.79 | $77.62 | $186.21 |
United Setting Professional Modifier None Typical Low $72.44 Median $147.91 Typical High $269.15 | Professional | None | $72.44 | $147.91 | $269.15 |
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 $35.48 Median $38.90 Typical High $93.33 | Professional | 52 · Reduced service | $35.48 | $38.90 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $14.13 Median $15.85 Typical High $37.15 | Professional | 53 · Discontinued | $14.13 | $15.85 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $53.70 Median $58.88 Typical High $141.25 | Professional | 54 · Surgery only | $53.70 | $58.88 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $10.72 Median $11.75 Typical High $28.18 | Professional | 55 · Aftercare only | $10.72 | $11.75 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.08 Median $7.76 Typical High $18.62 | Professional | 56 · Pre-op care only | $7.08 | $7.76 | $18.62 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $35.48 Median $38.90 Typical High $93.33 | Professional | 52 · Reduced service | $35.48 | $38.90 | $93.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $14.13 Median $15.49 Typical High $37.15 | Professional | 53 · Discontinued | $14.13 | $15.49 | $37.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $53.70 Median $57.54 Typical High $141.25 | Professional | 54 · Surgery only | $53.70 | $57.54 | $141.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $10.72 Median $11.48 Typical High $28.18 | Professional | 55 · Aftercare only | $10.72 | $11.48 | $28.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $7.08 Median $7.76 Typical High $18.62 | Professional | 56 · Pre-op care only | $7.08 | $7.76 | $18.62 |
Where Maine sits
The same service costs 3.7 times more in Wisconsin 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· 29th of 51
$151
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.