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 $85.11 Median $117.49 Typical High $177.83 | Professional | None | $85.11 | $117.49 | $177.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $81.28 Median $134.90 Typical High $223.87 | Professional | None | $81.28 | $134.90 | $223.87 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $134.90 Median $204.17 Typical High $346.74 | Professional | 50 · Both sides | $134.90 | $204.17 | $346.74 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $120.23 Typical High $707.95 | Facility | None | $56.23 | $120.23 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $165.96 Typical High $229.09 | Professional | None | $114.82 | $165.96 | $229.09 |
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 $95.50 Median $151.36 Typical High $239.88 | Professional | None | $95.50 | $151.36 | $239.88 |
Martin's Point Setting Professional Modifier None Typical Low $85.11 Median $117.49 Typical High $173.78 | Professional | None | $85.11 | $117.49 | $173.78 |
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 $112.20 Median $151.36 Typical High $208.93 | Professional | None | $112.20 | $151.36 | $208.93 |
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 $41.69 Median $58.88 Typical High $58.88 | Professional | 52 · Reduced service | $41.69 | $58.88 | $58.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $23.44 Typical High $23.44 | Professional | 53 · Discontinued | $16.98 | $23.44 | $23.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $89.13 Typical High $89.13 | Professional | 54 · Surgery only | $63.10 | $89.13 | $89.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $17.78 Typical High $17.78 | Professional | 55 · Aftercare only | $12.59 | $17.78 | $17.78 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $11.75 Typical High $11.75 | Professional | 56 · Pre-op care only | $8.51 | $11.75 | $11.75 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $41.69 Median $58.88 Typical High $58.88 | Professional | 52 · Reduced service | $41.69 | $58.88 | $58.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $23.44 Typical High $23.44 | Professional | 53 · Discontinued | $16.98 | $23.44 | $23.44 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $63.10 Median $89.13 Typical High $89.13 | Professional | 54 · Surgery only | $63.10 | $89.13 | $89.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $12.59 Median $17.78 Typical High $17.78 | Professional | 55 · Aftercare only | $12.59 | $17.78 | $17.78 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $11.75 Typical High $11.75 | Professional | 56 · Pre-op care only | $8.51 | $11.75 | $11.75 |
Where Maine sits
The same service costs 3.2 times more in Wisconsin than in Texas. 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· 33rd of 51
$135
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.