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 $23.99 Median $40.74 Typical High $44.67 | Professional | None | $23.99 | $40.74 | $44.67 |
Anthem BCBS Setting Professional Modifier None Typical Low $19.05 Median $25.12 Typical High $41.69 | Professional | None | $19.05 | $25.12 | $41.69 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $30.90 Median $44.67 Typical High $63.10 | Professional | 50 · Both sides | $30.90 | $44.67 | $63.10 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $29.51 Median $33.88 Typical High $43.65 | Professional | None | $29.51 | $33.88 | $43.65 |
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 $22.91 Median $36.31 Typical High $81.28 | Professional | None | $22.91 | $36.31 | $81.28 |
Martin's Point Setting Professional Modifier None Typical Low $23.99 Median $40.74 Typical High $44.67 | Professional | None | $23.99 | $40.74 | $44.67 |
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 $26.92 Median $54.95 Typical High $83.18 | Professional | None | $26.92 | $54.95 | $83.18 |
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 $20.42 Median $20.42 Typical High $21.88 | Professional | 52 · Reduced service | $20.42 | $20.42 | $21.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $8.13 Median $8.13 Typical High $8.71 | Professional | 53 · Discontinued | $8.13 | $8.13 | $8.71 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $30.90 Median $30.90 Typical High $32.36 | Professional | 54 · Surgery only | $30.90 | $30.90 | $32.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.17 Median $6.17 Typical High $6.46 | Professional | 55 · Aftercare only | $6.17 | $6.17 | $6.46 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.07 Median $4.07 Typical High $4.37 | Professional | 56 · Pre-op care only | $4.07 | $4.07 | $4.37 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $20.42 Median $20.42 Typical High $21.88 | Professional | 52 · Reduced service | $20.42 | $20.42 | $21.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $8.13 Median $8.13 Typical High $8.71 | Professional | 53 · Discontinued | $8.13 | $8.13 | $8.71 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $30.90 Median $30.90 Typical High $32.36 | Professional | 54 · Surgery only | $30.90 | $30.90 | $32.36 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $6.17 Median $6.17 Typical High $6.46 | Professional | 55 · Aftercare only | $6.17 | $6.17 | $6.46 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.07 Median $4.07 Typical High $4.37 | Professional | 56 · Pre-op care only | $4.07 | $4.07 | $4.37 |
Where Maine sits
The same service costs 4.3 times more in Wyoming than in New York. 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
$35.48
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.