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 $13.80 Median $13.80 Typical High $20.89 | Facility | None | $13.80 | $13.80 | $20.89 |
Aetna Setting Professional Modifier None Typical Low $13.80 Median $13.80 Typical High $27.54 | Professional | None | $13.80 | $13.80 | $27.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $13.49 Median $19.95 Typical High $30.20 | Professional | None | $13.49 | $19.95 | $30.20 |
Anthem BCBS Setting Professional Modifier 50 · Both sides Typical Low $20.42 Median $30.20 Typical High $45.71 | Professional | 50 · Both sides | $20.42 | $30.20 | $45.71 |
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 $19.05 Median $20.42 Typical High $35.48 | Professional | None | $19.05 | $20.42 | $35.48 |
Community Health Options Setting Professional Modifier None Typical Low $25.12 Median $31.62 Typical High $31.62 | Professional | None | $25.12 | $31.62 | $31.62 |
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 $15.85 Median $20.89 Typical High $33.11 | Professional | None | $15.85 | $20.89 | $33.11 |
Martin's Point Setting Facility Modifier None Typical Low $13.80 Median $19.95 Typical High $2,398.83 | Facility | None | $13.80 | $19.95 | $2,398.83 |
Martin's Point Setting Professional Modifier None Typical Low $13.80 Median $13.80 Typical High $27.54 | Professional | None | $13.80 | $13.80 | $27.54 |
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 $14.45 Median $19.50 Typical High $33.11 | Professional | None | $14.45 | $19.50 | $33.11 |
5 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 $6.92 Median $6.92 Typical High $6.92 | Professional | 52 · Reduced service | $6.92 | $6.92 | $6.92 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.75 Median $2.75 Typical High $2.75 | Professional | 53 · Discontinued | $2.75 | $2.75 | $2.75 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $10.23 Median $10.23 Typical High $10.23 | Professional | 54 · Surgery only | $10.23 | $10.23 | $10.23 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.04 Median $2.04 Typical High $2.04 | Professional | 55 · Aftercare only | $2.04 | $2.04 | $2.04 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.38 Median $1.38 Typical High $1.38 | Professional | 56 · Pre-op care only | $1.38 | $1.38 | $1.38 |
Where Maine sits
The same service costs 7.4 times more in Kansas 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· 32nd of 51
$20.42
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.