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 $51.29 Median $58.88 Typical High $89.13 | Professional | None | $51.29 | $58.88 | $89.13 |
Anthem BCBS Setting Professional Modifier None Typical Low $38.90 Median $75.86 Typical High $141.25 | Professional | None | $38.90 | $75.86 | $141.25 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $53.70 Median $93.33 Typical High $144.54 | Professional | None | $53.70 | $93.33 | $144.54 |
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 $44.67 Median $79.43 Typical High $147.91 | Professional | None | $44.67 | $79.43 | $147.91 |
Martin's Point Setting Professional Modifier None Typical Low $51.29 Median $58.88 Typical High $89.13 | Professional | None | $51.29 | $58.88 | $89.13 |
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 $53.70 Median $79.43 Typical High $123.03 | Professional | None | $53.70 | $79.43 | $123.03 |
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 $25.70 Median $28.84 Typical High $44.67 | Professional | 52 · Reduced service | $25.70 | $28.84 | $44.67 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $11.75 Typical High $17.78 | Professional | 53 · Discontinued | $10.47 | $11.75 | $17.78 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.90 Median $43.65 Typical High $67.61 | Professional | 54 · Surgery only | $38.90 | $43.65 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $8.71 Typical High $13.49 | Professional | 55 · Aftercare only | $7.76 | $8.71 | $13.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $5.89 Typical High $8.91 | Professional | 56 · Pre-op care only | $5.25 | $5.89 | $8.91 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $25.70 Median $28.84 Typical High $44.67 | Professional | 52 · Reduced service | $25.70 | $28.84 | $44.67 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $11.75 Typical High $17.78 | Professional | 53 · Discontinued | $10.47 | $11.75 | $17.78 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $38.90 Median $43.65 Typical High $67.61 | Professional | 54 · Surgery only | $38.90 | $43.65 | $67.61 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.76 Median $8.71 Typical High $13.49 | Professional | 55 · Aftercare only | $7.76 | $8.71 | $13.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $5.89 Typical High $8.91 | Professional | 56 · Pre-op care only | $5.25 | $5.89 | $8.91 |
Where Maine sits
The same service costs 3.4 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· 34th of 51
$77.62
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.