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 Facility Modifier None Typical Low $85.11 Median $85.11 Typical High $467.74 | Facility | None | $85.11 | $85.11 | $467.74 |
Aetna Setting Professional Modifier None Typical Low $85.11 Median $109.65 Typical High $467.74 | Professional | None | $85.11 | $109.65 | $467.74 |
Anthem BCBS Setting Professional Modifier None Typical Low $77.62 Median $281.84 Typical High $676.08 | Professional | None | $77.62 | $281.84 | $676.08 |
Cigna Setting Professional Modifier None Typical Low $100.00 Median $398.11 Typical High $794.33 | Professional | None | $100.00 | $398.11 | $794.33 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $75.86 Median $338.84 Typical High $758.58 | Professional | None | $75.86 | $338.84 | $758.58 |
Martin's Point Setting Professional Modifier None Typical Low $85.11 Median $109.65 Typical High $467.74 | Professional | None | $85.11 | $109.65 | $467.74 |
United Setting Professional Modifier None Typical Low $87.10 Median $239.88 Typical High $660.69 | Professional | None | $87.10 | $239.88 | $660.69 |
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 $42.66 Median $54.95 Typical High $234.42 | Professional | 52 · Reduced service | $42.66 | $54.95 | $234.42 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $21.88 Typical High $93.33 | Professional | 53 · Discontinued | $17.38 | $21.88 | $93.33 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $64.57 Median $81.28 Typical High $354.81 | Professional | 54 · Surgery only | $64.57 | $81.28 | $354.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $16.22 Typical High $70.79 | Professional | 55 · Aftercare only | $12.88 | $16.22 | $70.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $10.96 Typical High $46.77 | Professional | 56 · Pre-op care only | $8.71 | $10.96 | $46.77 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $42.66 Median $54.95 Typical High $234.42 | Professional | 52 · Reduced service | $42.66 | $54.95 | $234.42 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $21.88 Typical High $93.33 | Professional | 53 · Discontinued | $17.38 | $21.88 | $93.33 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $64.57 Median $81.28 Typical High $354.81 | Professional | 54 · Surgery only | $64.57 | $81.28 | $354.81 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $16.22 Typical High $70.79 | Professional | 55 · Aftercare only | $12.88 | $16.22 | $70.79 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $46.77 Typical High $46.77 | Professional | 56 · Pre-op care only | $10.96 | $46.77 | $46.77 |
Where Maine sits
The same service costs 5.6 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· 41st of 51
$295
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.