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 $194.98 Median $199.53 Typical High $489.78 | Professional | None | $194.98 | $199.53 | $489.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $173.78 Median $323.59 Typical High $707.95 | Professional | None | $173.78 | $323.59 | $707.95 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $707.95 Typical High $1,412.54 | Facility | None | $691.83 | $707.95 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $288.40 Median $288.40 Typical High $288.40 | Professional | None | $288.40 | $288.40 | $288.40 |
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 $208.93 Median $389.05 Typical High $741.31 | Professional | None | $208.93 | $389.05 | $741.31 |
Martin's Point Setting Professional Modifier None Typical Low $194.98 Median $199.53 Typical High $489.78 | Professional | None | $194.98 | $199.53 | $489.78 |
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 $263.03 Median $478.63 Typical High $776.25 | Professional | None | $263.03 | $478.63 | $776.25 |
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 $97.72 Median $100.00 Typical High $245.47 | Professional | 52 · Reduced service | $97.72 | $100.00 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $39.81 Typical High $97.72 | Professional | 53 · Discontinued | $38.90 | $39.81 | $97.72 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $151.36 Typical High $371.54 | Professional | 54 · Surgery only | $144.54 | $151.36 | $371.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $30.20 Typical High $74.13 | Professional | 55 · Aftercare only | $29.51 | $30.20 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $19.95 Typical High $48.98 | Professional | 56 · Pre-op care only | $19.50 | $19.95 | $48.98 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $97.72 Median $100.00 Typical High $245.47 | Professional | 52 · Reduced service | $97.72 | $100.00 | $245.47 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $38.90 Median $39.81 Typical High $97.72 | Professional | 53 · Discontinued | $38.90 | $39.81 | $97.72 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $144.54 Median $151.36 Typical High $371.54 | Professional | 54 · Surgery only | $144.54 | $151.36 | $371.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $30.20 Typical High $74.13 | Professional | 55 · Aftercare only | $29.51 | $30.20 | $74.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.50 Median $19.95 Typical High $48.98 | Professional | 56 · Pre-op care only | $19.50 | $19.95 | $48.98 |
Where Maine sits
The same service costs 2.8 times more in Wisconsin than in Utah. 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· 36th of 51
$339
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.