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 $64.57 Median $64.57 Typical High $97.72 | Facility | None | $64.57 | $64.57 | $97.72 |
Aetna Setting Professional Modifier None Typical Low $64.57 Median $97.72 Typical High $158.49 | Professional | None | $64.57 | $97.72 | $158.49 |
Anthem BCBS Setting Professional Modifier None Typical Low $60.26 Median $104.71 Typical High $194.98 | Professional | None | $60.26 | $104.71 | $194.98 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $85.11 Typical High $707.95 | Facility | None | $56.23 | $85.11 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $87.10 Median $134.90 Typical High $190.55 | Professional | None | $87.10 | $134.90 | $190.55 |
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 $79.43 Median $123.03 Typical High $186.21 | Professional | None | $79.43 | $123.03 | $186.21 |
Martin's Point Setting Professional Modifier None Typical Low $64.57 Median $97.72 Typical High $158.49 | Professional | None | $64.57 | $97.72 | $158.49 |
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 $97.72 Median $141.25 Typical High $181.97 | Professional | None | $97.72 | $141.25 | $181.97 |
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 $32.36 Median $47.86 Typical High $48.98 | Professional | 52 · Reduced service | $32.36 | $47.86 | $48.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $12.88 Median $19.05 Typical High $19.95 | Professional | 53 · Discontinued | $12.88 | $19.05 | $19.95 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $48.98 Median $70.79 Typical High $74.13 | Professional | 54 · Surgery only | $48.98 | $70.79 | $74.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $14.13 Typical High $14.79 | Professional | 55 · Aftercare only | $9.77 | $14.13 | $14.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $6.46 Median $9.55 Typical High $9.77 | Professional | 56 · Pre-op care only | $6.46 | $9.55 | $9.77 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $32.36 Median $46.77 Typical High $48.98 | Professional | 52 · Reduced service | $32.36 | $46.77 | $48.98 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $12.88 Median $18.62 Typical High $19.95 | Professional | 53 · Discontinued | $12.88 | $18.62 | $19.95 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $48.98 Median $70.79 Typical High $74.13 | Professional | 54 · Surgery only | $48.98 | $70.79 | $74.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $9.77 Median $14.13 Typical High $14.79 | Professional | 55 · Aftercare only | $9.77 | $14.13 | $14.79 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $6.46 Median $9.33 Typical High $9.77 | Professional | 56 · Pre-op care only | $6.46 | $9.33 | $9.77 |
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· 40th of 51
$107
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.