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 $251.19 Median $331.13 Typical High $416.87 | Professional | None | $251.19 | $331.13 | $416.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $190.55 Median $371.54 Typical High $630.96 | Professional | None | $190.55 | $371.54 | $630.96 |
Cigna Setting Facility Modifier None Typical Low $354.81 Median $616.60 Typical High $1,862.09 | Facility | None | $354.81 | $616.60 | $1,862.09 |
Cigna Setting Professional Modifier None Typical Low $263.03 Median $436.52 Typical High $630.96 | Professional | None | $263.03 | $436.52 | $630.96 |
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 $218.78 Median $363.08 Typical High $616.60 | Professional | None | $218.78 | $363.08 | $616.60 |
Martin's Point Setting Professional Modifier None Typical Low $229.09 Median $331.13 Typical High $416.87 | Professional | None | $229.09 | $331.13 | $416.87 |
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 $257.04 Median $363.08 Typical High $549.54 | Professional | None | $257.04 | $363.08 | $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 $125.89 Median $141.25 Typical High $208.93 | Professional | 52 · Reduced service | $125.89 | $141.25 | $208.93 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $50.12 Median $56.23 Typical High $83.18 | Professional | 53 · Discontinued | $50.12 | $56.23 | $83.18 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $186.21 Median $213.80 Typical High $309.03 | Professional | 54 · Surgery only | $186.21 | $213.80 | $309.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $37.15 Median $42.66 Typical High $61.66 | Professional | 55 · Aftercare only | $37.15 | $42.66 | $61.66 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $25.12 Median $28.18 Typical High $41.69 | Professional | 56 · Pre-op care only | $25.12 | $28.18 | $41.69 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $125.89 Median $141.25 Typical High $208.93 | Professional | 52 · Reduced service | $125.89 | $141.25 | $208.93 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $50.12 Median $56.23 Typical High $83.18 | Professional | 53 · Discontinued | $50.12 | $56.23 | $83.18 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $186.21 Median $213.80 Typical High $309.03 | Professional | 54 · Surgery only | $186.21 | $213.80 | $309.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $37.15 Median $42.66 Typical High $61.66 | Professional | 55 · Aftercare only | $37.15 | $42.66 | $61.66 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $25.12 Median $28.18 Typical High $41.69 | Professional | 56 · Pre-op care only | $25.12 | $28.18 | $41.69 |
Where Maine sits
The same service costs 3.0 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· 29th of 51
$372
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.