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 $47.86 Median $95.50 Typical High $190.55 | Professional | None | $47.86 | $95.50 | $190.55 |
Anthem BCBS Setting Professional Modifier None Typical Low $46.77 Median $125.89 Typical High $288.40 | Professional | None | $46.77 | $125.89 | $288.40 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $56.23 Median $144.54 Typical High $309.03 | Professional | None | $56.23 | $144.54 | $309.03 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $46.77 Median $134.90 Typical High $323.59 | Professional | None | $46.77 | $134.90 | $323.59 |
Martin's Point Setting Professional Modifier None Typical Low $47.86 Median $95.50 Typical High $190.55 | Professional | None | $47.86 | $95.50 | $190.55 |
United Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
United Setting Professional Modifier None Typical Low $40.74 Median $120.23 Typical High $263.03 | Professional | None | $40.74 | $120.23 | $263.03 |
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 $23.44 Median $47.86 Typical High $95.50 | Professional | 52 · Reduced service | $23.44 | $47.86 | $95.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.55 Median $19.05 Typical High $38.02 | Professional | 53 · Discontinued | $9.55 | $19.05 | $38.02 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $72.44 Typical High $141.25 | Professional | 54 · Surgery only | $35.48 | $72.44 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $14.45 Typical High $28.84 | Professional | 55 · Aftercare only | $7.08 | $14.45 | $28.84 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.79 Median $9.55 Typical High $19.05 | Professional | 56 · Pre-op care only | $4.79 | $9.55 | $19.05 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $23.99 Median $47.86 Typical High $95.50 | Professional | 52 · Reduced service | $23.99 | $47.86 | $95.50 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $9.55 Median $19.05 Typical High $38.02 | Professional | 53 · Discontinued | $9.55 | $19.05 | $38.02 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $36.31 Median $72.44 Typical High $141.25 | Professional | 54 · Surgery only | $36.31 | $72.44 | $141.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.24 Median $14.45 Typical High $28.84 | Professional | 55 · Aftercare only | $7.24 | $14.45 | $28.84 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.79 Median $9.55 Typical High $19.05 | Professional | 56 · Pre-op care only | $4.79 | $9.55 | $19.05 |
Where Maine sits
The same service costs 4.6 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· 30th of 51
$126
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.