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 $134.90 Median $204.17 Typical High $245.47 | Professional | None | $134.90 | $204.17 | $245.47 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,023.29 Median $1,023.29 Typical High $1,023.29 | Facility | None | $1,023.29 | $1,023.29 | $1,023.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $125.89 Median $208.93 Typical High $407.38 | Professional | None | $125.89 | $208.93 | $407.38 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $891.25 Typical High $1,412.54 | Facility | None | $537.03 | $891.25 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $151.36 Median $251.19 Typical High $416.87 | Professional | None | $151.36 | $251.19 | $416.87 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $125.89 Median $204.17 Typical High $446.68 | Professional | None | $125.89 | $204.17 | $446.68 |
Martin's Point Setting Professional Modifier None Typical Low $134.90 Median $204.17 Typical High $245.47 | Professional | None | $134.90 | $204.17 | $245.47 |
United Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
United Setting Professional Modifier None Typical Low $112.20 Median $204.17 Typical High $407.38 | Professional | None | $112.20 | $204.17 | $407.38 |
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 $67.61 Median $102.33 Typical High $123.03 | Professional | 52 · Reduced service | $67.61 | $102.33 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $40.74 Typical High $48.98 | Professional | 53 · Discontinued | $26.92 | $40.74 | $48.98 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $154.88 Typical High $181.97 | Professional | 54 · Surgery only | $100.00 | $154.88 | $181.97 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $30.90 Typical High $36.31 | Professional | 55 · Aftercare only | $19.95 | $30.90 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $13.49 Median $20.42 Typical High $24.55 | Professional | 56 · Pre-op care only | $13.49 | $20.42 | $24.55 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $67.61 Median $102.33 Typical High $123.03 | Professional | 52 · Reduced service | $67.61 | $102.33 | $123.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $26.92 Median $40.74 Typical High $48.98 | Professional | 53 · Discontinued | $26.92 | $40.74 | $48.98 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $100.00 Median $154.88 Typical High $181.97 | Professional | 54 · Surgery only | $100.00 | $154.88 | $181.97 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $19.95 Median $30.90 Typical High $36.31 | Professional | 55 · Aftercare only | $19.95 | $30.90 | $36.31 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $13.49 Median $20.42 Typical High $24.55 | Professional | 56 · Pre-op care only | $13.49 | $20.42 | $24.55 |
Where Maine sits
The same service costs 3.8 times more in Alaska 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
$209
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.