How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $64.57 Median $81.28 Typical High $186.21 | Professional | None | $64.57 | $81.28 | $186.21 |
Anthem BCBS Setting Professional Modifier None Typical Low $57.54 Median $134.90 Typical High $281.84 | Professional | None | $57.54 | $134.90 | $281.84 |
Cigna Setting Professional Modifier None Typical Low $85.11 Median $144.54 Typical High $295.12 | Professional | None | $85.11 | $144.54 | $295.12 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $70.79 Median $165.96 Typical High $288.40 | Professional | None | $70.79 | $165.96 | $288.40 |
Martin's Point Setting Professional Modifier None Typical Low $70.79 Median $81.28 Typical High $190.55 | Professional | None | $70.79 | $81.28 | $190.55 |
United Setting Professional Modifier None Typical Low $100.00 Median $169.82 Typical High $302.00 | Professional | None | $100.00 | $169.82 | $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 $38.90 Median $38.90 Typical High $93.33 | Professional | 52 · Reduced service | $38.90 | $38.90 | $93.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.49 Median $15.49 Typical High $37.15 | Professional | 53 · Discontinued | $15.49 | $15.49 | $37.15 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $58.88 Median $58.88 Typical High $141.25 | Professional | 54 · Surgery only | $58.88 | $58.88 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.75 Median $11.75 Typical High $28.18 | Professional | 55 · Aftercare only | $11.75 | $11.75 | $28.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $7.76 Typical High $18.62 | Professional | 56 · Pre-op care only | $7.76 | $7.76 | $18.62 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $38.90 Median $38.90 Typical High $93.33 | Professional | 52 · Reduced service | $38.90 | $38.90 | $93.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $15.49 Median $15.49 Typical High $37.15 | Professional | 53 · Discontinued | $15.49 | $15.49 | $37.15 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $58.88 Median $58.88 Typical High $141.25 | Professional | 54 · Surgery only | $58.88 | $58.88 | $141.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $11.75 Median $11.75 Typical High $28.18 | Professional | 55 · Aftercare only | $11.75 | $11.75 | $28.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $7.76 Median $7.76 Typical High $18.62 | Professional | 56 · Pre-op care only | $7.76 | $7.76 | $18.62 |
Where Maine sits
The same service costs 3.5 times more in Alaska than in Maryland. 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· 34th of 51
$145
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.