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 $194.98 Median $194.98 Typical High $416.87 | Facility | None | $194.98 | $194.98 | $416.87 |
Aetna Setting Professional Modifier None Typical Low $190.55 Median $338.84 Typical High $501.19 | Professional | None | $190.55 | $338.84 | $501.19 |
Anthem BCBS Setting Professional Modifier None Typical Low $147.91 Median $288.40 Typical High $575.44 | Professional | None | $147.91 | $288.40 | $575.44 |
Cigna Setting Facility Modifier None Typical Low $707.95 Median $1,348.96 Typical High $1,862.09 | Facility | None | $707.95 | $1,348.96 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $354.81 Typical High $588.84 | Professional | None | $204.17 | $354.81 | $588.84 |
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 $169.82 Median $323.59 Typical High $588.84 | Professional | None | $169.82 | $323.59 | $588.84 |
Martin's Point Setting Professional Modifier None Typical Low $190.55 Median $331.13 Typical High $501.19 | Professional | None | $190.55 | $331.13 | $501.19 |
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 $199.53 Median $309.03 Typical High $549.54 | Professional | None | $199.53 | $309.03 | $549.54 |
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 $97.72 Median $104.71 Typical High $204.17 | Professional | 52 · Reduced service | $97.72 | $104.71 | $204.17 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $42.66 Typical High $83.18 | Professional | 53 · Discontinued | $38.90 | $42.66 | $83.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $158.49 Typical High $309.03 | Professional | 54 · Surgery only | $144.54 | $158.49 | $309.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $31.62 Typical High $61.66 | Professional | 55 · Aftercare only | $28.84 | $31.62 | $61.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $21.38 Typical High $41.69 | Professional | 56 · Pre-op care only | $19.50 | $21.38 | $41.69 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $97.72 Median $104.71 Typical High $204.17 | Professional | 52 · Reduced service | $97.72 | $104.71 | $204.17 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $42.66 Typical High $83.18 | Professional | 53 · Discontinued | $38.90 | $42.66 | $83.18 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $158.49 Typical High $309.03 | Professional | 54 · Surgery only | $144.54 | $158.49 | $309.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $31.62 Typical High $61.66 | Professional | 55 · Aftercare only | $28.84 | $31.62 | $61.66 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $21.38 Typical High $41.69 | Professional | 56 · Pre-op care only | $19.50 | $21.38 | $41.69 |
Where Maine sits
The same service costs 3.0 times more in Wisconsin than in Utah. 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· 44th of 51
$316
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.