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 $39.81 Median $39.81 Typical High $95.50 | Facility | None | $39.81 | $39.81 | $95.50 |
Aetna Setting Professional Modifier None Typical Low $39.81 Median $63.10 Typical High $128.82 | Professional | None | $39.81 | $63.10 | $128.82 |
Anthem BCBS Setting Professional Modifier None Typical Low $30.20 Median $58.88 Typical High $141.25 | Professional | None | $30.20 | $58.88 | $141.25 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $91.20 Typical High $707.95 | Facility | None | $56.23 | $91.20 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $41.69 Median $95.50 Typical High $147.91 | Professional | None | $41.69 | $95.50 | $147.91 |
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 $37.15 Median $77.62 Typical High $147.91 | Professional | None | $37.15 | $77.62 | $147.91 |
Martin's Point Setting Professional Modifier None Typical Low $39.81 Median $63.10 Typical High $128.82 | Professional | None | $39.81 | $63.10 | $128.82 |
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 $48.98 Median $77.62 Typical High $138.04 | Professional | None | $48.98 | $77.62 | $138.04 |
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 $19.95 Median $31.62 Typical High $47.86 | Professional | 52 · Reduced service | $19.95 | $31.62 | $47.86 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $12.88 Typical High $19.05 | Professional | 53 · Discontinued | $7.94 | $12.88 | $19.05 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $29.51 Median $47.86 Typical High $72.44 | Professional | 54 · Surgery only | $29.51 | $47.86 | $72.44 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.89 Median $9.55 Typical High $14.45 | Professional | 55 · Aftercare only | $5.89 | $9.55 | $14.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.98 Median $6.31 Typical High $9.55 | Professional | 56 · Pre-op care only | $3.98 | $6.31 | $9.55 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $19.95 Median $31.62 Typical High $47.86 | Professional | 52 · Reduced service | $19.95 | $31.62 | $47.86 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $12.88 Typical High $19.05 | Professional | 53 · Discontinued | $7.94 | $12.88 | $19.05 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $29.51 Median $47.86 Typical High $72.44 | Professional | 54 · Surgery only | $29.51 | $47.86 | $72.44 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $5.89 Median $9.55 Typical High $14.45 | Professional | 55 · Aftercare only | $5.89 | $9.55 | $14.45 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.98 Median $6.31 Typical High $9.55 | Professional | 56 · Pre-op care only | $3.98 | $6.31 | $9.55 |
Where Maine sits
The same service costs 3.1 times more in Wisconsin than in Nebraska. 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· 42nd of 51
$75.86
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.