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 $45.71 Median $46.77 Typical High $81.28 | Facility | None | $45.71 | $46.77 | $81.28 |
Aetna Setting Professional Modifier None Typical Low $46.77 Median $69.18 Typical High $114.82 | Professional | None | $46.77 | $69.18 | $114.82 |
Anthem BCBS Setting Professional Modifier None Typical Low $44.67 Median $77.62 Typical High $141.25 | Professional | None | $44.67 | $77.62 | $141.25 |
Cigna Setting Facility Modifier None Typical Low $41.69 Median $60.26 Typical High $707.95 | Facility | None | $41.69 | $60.26 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $61.66 Median $100.00 Typical High $141.25 | Professional | None | $61.66 | $100.00 | $141.25 |
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 $50.12 Median $87.10 Typical High $134.90 | Professional | None | $50.12 | $87.10 | $134.90 |
Martin's Point Setting Facility Modifier None Typical Low $45.71 Median $46.77 Typical High $81.28 | Facility | None | $45.71 | $46.77 | $81.28 |
Martin's Point Setting Professional Modifier None Typical Low $46.77 Median $66.07 Typical High $114.82 | Professional | None | $46.77 | $66.07 | $114.82 |
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 $61.66 Median $89.13 Typical High $125.89 | Professional | None | $61.66 | $89.13 | $125.89 |
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 $23.44 Median $25.70 Typical High $34.67 | Professional | 52 · Reduced service | $23.44 | $25.70 | $34.67 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $10.23 Typical High $13.80 | Professional | 53 · Discontinued | $9.33 | $10.23 | $13.80 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $38.02 Typical High $52.48 | Professional | 54 · Surgery only | $35.48 | $38.02 | $52.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $7.59 Typical High $10.47 | Professional | 55 · Aftercare only | $7.08 | $7.59 | $10.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $5.13 Typical High $6.92 | Professional | 56 · Pre-op care only | $4.68 | $5.13 | $6.92 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $23.44 Median $25.70 Typical High $34.67 | Professional | 52 · Reduced service | $23.44 | $25.70 | $34.67 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $9.33 Median $10.23 Typical High $13.80 | Professional | 53 · Discontinued | $9.33 | $10.23 | $13.80 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $38.02 Typical High $52.48 | Professional | 54 · Surgery only | $35.48 | $38.02 | $52.48 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $7.59 Typical High $10.47 | Professional | 55 · Aftercare only | $7.08 | $7.59 | $10.47 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.68 Median $5.13 Typical High $6.92 | Professional | 56 · Pre-op care only | $4.68 | $5.13 | $6.92 |
Where Maine sits
The same service costs 3.1 times more in Wisconsin than in Washington, DC. 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· 37th of 51
$75.86
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.