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 $144.54 Median $144.54 Typical High $309.03 | Facility | None | $144.54 | $144.54 | $309.03 |
Aetna Setting Professional Modifier None Typical Low $141.25 Median $190.55 Typical High $309.03 | Professional | None | $141.25 | $190.55 | $309.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $102.33 Median $165.96 Typical High $251.19 | Professional | None | $102.33 | $165.96 | $251.19 |
Cigna Setting Professional Modifier None Typical Low $147.91 Median $316.23 Typical High $549.54 | Professional | None | $147.91 | $316.23 | $549.54 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $125.89 Median $263.03 Typical High $467.74 | Professional | None | $125.89 | $263.03 | $467.74 |
Martin's Point Setting Professional Modifier None Typical Low $144.54 Median $190.55 Typical High $309.03 | Professional | None | $144.54 | $190.55 | $309.03 |
United Setting Professional Modifier None Typical Low $154.88 Median $257.04 Typical High $436.52 | Professional | None | $154.88 | $257.04 | $436.52 |
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 $70.79 Median $95.50 Typical High $154.88 | Professional | 52 · Reduced service | $70.79 | $95.50 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.18 Median $38.02 Typical High $61.66 | Professional | 53 · Discontinued | $28.18 | $38.02 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $104.71 Median $141.25 Typical High $229.09 | Professional | 54 · Surgery only | $104.71 | $141.25 | $229.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $20.89 Median $28.18 Typical High $45.71 | Professional | 55 · Aftercare only | $20.89 | $28.18 | $45.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.13 Median $19.05 Typical High $30.90 | Professional | 56 · Pre-op care only | $14.13 | $19.05 | $30.90 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $72.44 Median $95.50 Typical High $154.88 | Professional | 52 · Reduced service | $72.44 | $95.50 | $154.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $38.02 Typical High $61.66 | Professional | 53 · Discontinued | $28.84 | $38.02 | $61.66 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $107.15 Median $141.25 Typical High $229.09 | Professional | 54 · Surgery only | $107.15 | $141.25 | $229.09 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $28.18 Typical High $45.71 | Professional | 55 · Aftercare only | $21.38 | $28.18 | $45.71 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $19.05 Typical High $30.90 | Professional | 56 · Pre-op care only | $14.45 | $19.05 | $30.90 |
Where Maine sits
The same service costs 3.4 times more in Alaska than in Virginia. 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· 44th of 51
$209
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.