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 $102.33 Median $144.54 Typical High $190.55 | Professional | None | $102.33 | $144.54 | $190.55 |
Anthem BCBS Setting Professional Modifier None Typical Low $77.62 Median $151.36 Typical High $257.04 | Professional | None | $77.62 | $151.36 | $257.04 |
Cigna Setting Facility Modifier None Typical Low $354.81 Median $537.03 Typical High $1,412.54 | Facility | None | $354.81 | $537.03 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $107.15 Median $181.97 Typical High $263.03 | Professional | None | $107.15 | $181.97 | $263.03 |
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 $91.20 Median $158.49 Typical High $269.15 | Professional | None | $91.20 | $158.49 | $269.15 |
Martin's Point Setting Professional Modifier None Typical Low $102.33 Median $144.54 Typical High $186.21 | Professional | None | $102.33 | $144.54 | $186.21 |
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 $107.15 Median $158.49 Typical High $229.09 | Professional | None | $107.15 | $158.49 | $229.09 |
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 $51.29 Median $69.18 Typical High $85.11 | Professional | 52 · Reduced service | $51.29 | $69.18 | $85.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $27.54 Typical High $33.88 | Professional | 53 · Discontinued | $20.42 | $27.54 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $102.33 Typical High $125.89 | Professional | 54 · Surgery only | $75.86 | $102.33 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $20.89 Typical High $25.12 | Professional | 55 · Aftercare only | $15.14 | $20.89 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $13.80 Typical High $16.98 | Professional | 56 · Pre-op care only | $10.23 | $13.80 | $16.98 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $51.29 Median $69.18 Typical High $85.11 | Professional | 52 · Reduced service | $51.29 | $69.18 | $85.11 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $20.42 Median $27.54 Typical High $33.88 | Professional | 53 · Discontinued | $20.42 | $27.54 | $33.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $102.33 Typical High $125.89 | Professional | 54 · Surgery only | $75.86 | $102.33 | $125.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $20.89 Typical High $25.12 | Professional | 55 · Aftercare only | $15.14 | $20.89 | $25.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $13.80 Typical High $16.98 | Professional | 56 · Pre-op care only | $10.23 | $13.80 | $16.98 |
Where Maine sits
The same service costs 3.6 times more in Wisconsin than in Kentucky. 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· 36th of 51
$151
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.