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 $123.03 Median $123.03 Typical High $169.82 | Facility | None | $123.03 | $123.03 | $169.82 |
Aetna Setting Professional Modifier None Typical Low $123.03 Median $162.18 Typical High $245.47 | Professional | None | $123.03 | $162.18 | $245.47 |
Anthem BCBS Setting Professional Modifier None Typical Low $117.49 Median $186.21 Typical High $338.84 | Professional | None | $117.49 | $186.21 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $109.65 Median $251.19 Typical High $1,412.54 | Facility | None | $109.65 | $251.19 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $165.96 Median $229.09 Typical High $338.84 | Professional | None | $165.96 | $229.09 | $338.84 |
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 $138.04 Median $208.93 Typical High $346.74 | Professional | None | $138.04 | $208.93 | $346.74 |
Martin's Point Setting Professional Modifier None Typical Low $123.03 Median $162.18 Typical High $245.47 | Professional | None | $123.03 | $162.18 | $245.47 |
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 $162.18 Median $208.93 Typical High $302.00 | Professional | None | $162.18 | $208.93 | $302.00 |
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 $61.66 Median $66.07 Typical High $85.11 | Professional | 52 · Reduced service | $61.66 | $66.07 | $85.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $26.30 Typical High $33.88 | Professional | 53 · Discontinued | $24.55 | $26.30 | $33.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $100.00 Typical High $128.82 | Professional | 54 · Surgery only | $93.33 | $100.00 | $128.82 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $19.95 Typical High $25.70 | Professional | 55 · Aftercare only | $18.62 | $19.95 | $25.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $13.18 Typical High $16.98 | Professional | 56 · Pre-op care only | $12.30 | $13.18 | $16.98 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $61.66 Median $66.07 Typical High $85.11 | Professional | 52 · Reduced service | $61.66 | $66.07 | $85.11 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $24.55 Median $26.30 Typical High $33.88 | Professional | 53 · Discontinued | $24.55 | $26.30 | $33.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $100.00 Typical High $128.82 | Professional | 54 · Surgery only | $93.33 | $100.00 | $128.82 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $19.95 Typical High $25.70 | Professional | 55 · Aftercare only | $18.62 | $19.95 | $25.70 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.30 Median $13.18 Typical High $16.98 | Professional | 56 · Pre-op care only | $12.30 | $13.18 | $16.98 |
Where Maine sits
The same service costs 3.7 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· 35th of 51
$186
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.