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 $95.50 Median $131.83 Typical High $407.38 | Professional | None | $95.50 | $131.83 | $407.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $100.00 Median $281.84 Typical High $602.56 | Professional | None | $100.00 | $281.84 | $602.56 |
Cigna Setting Facility Modifier None Typical Low $158.49 Median $354.81 Typical High $1,412.54 | Facility | None | $158.49 | $354.81 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $120.23 Median $302.00 Typical High $630.96 | Professional | None | $120.23 | $302.00 | $630.96 |
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 $102.33 Median $302.00 Typical High $707.95 | Professional | None | $102.33 | $302.00 | $707.95 |
Martin's Point Setting Professional Modifier None Typical Low $100.00 Median $131.83 Typical High $407.38 | Professional | None | $100.00 | $131.83 | $407.38 |
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 $85.11 Median $263.03 Typical High $562.34 | Professional | None | $85.11 | $263.03 | $562.34 |
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 $50.12 Median $57.54 Typical High $204.17 | Professional | 52 · Reduced service | $50.12 | $57.54 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $22.91 Typical High $81.28 | Professional | 53 · Discontinued | $20.42 | $22.91 | $81.28 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $85.11 Typical High $309.03 | Professional | 54 · Surgery only | $75.86 | $85.11 | $309.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $16.98 Typical High $61.66 | Professional | 55 · Aftercare only | $15.14 | $16.98 | $61.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $11.48 Typical High $40.74 | Professional | 56 · Pre-op care only | $10.00 | $11.48 | $40.74 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $50.12 Median $57.54 Typical High $204.17 | Professional | 52 · Reduced service | $50.12 | $57.54 | $204.17 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $22.91 Typical High $81.28 | Professional | 53 · Discontinued | $20.42 | $22.91 | $81.28 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $85.11 Typical High $309.03 | Professional | 54 · Surgery only | $75.86 | $85.11 | $309.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $16.98 Typical High $61.66 | Professional | 55 · Aftercare only | $15.14 | $16.98 | $61.66 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $30.90 Typical High $40.74 | Professional | 56 · Pre-op care only | $10.00 | $30.90 | $40.74 |
Where Maine sits
The same service costs 4.8 times more in Wisconsin than in Washington, DC. 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
$288
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.