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 $45.71 Median $45.71 Typical High $45.71 | Professional | None | $45.71 | $45.71 | $45.71 |
Anthem BCBS Setting Professional Modifier None Typical Low $95.50 Median $125.89 Typical High $173.78 | Professional | None | $95.50 | $125.89 | $173.78 |
Cigna Setting Facility Modifier None Typical Low $144.54 Median $190.55 Typical High $363.08 | Facility | None | $144.54 | $190.55 | $363.08 |
Cigna Setting Professional Modifier None Typical Low $125.89 Median $125.89 Typical High $125.89 | Professional | None | $125.89 | $125.89 | $125.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $45.71 Median $107.15 Typical High $177.83 | Professional | None | $45.71 | $107.15 | $177.83 |
Martin's Point Setting Professional Modifier None Typical Low $45.71 Median $45.71 Typical High $45.71 | Professional | None | $45.71 | $45.71 | $45.71 |
United Setting Professional Modifier None Typical Low $114.82 Median $125.89 Typical High $190.55 | Professional | None | $114.82 | $125.89 | $190.55 |
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 $22.39 Median $22.39 Typical High $22.39 | Professional | 52 · Reduced service | $22.39 | $22.39 | $22.39 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.12 Median $9.12 Typical High $9.12 | Professional | 53 · Discontinued | $9.12 | $9.12 | $9.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $33.88 Median $33.88 Typical High $33.88 | Professional | 54 · Surgery only | $33.88 | $33.88 | $33.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $6.76 Median $6.76 Typical High $6.76 | Professional | 55 · Aftercare only | $6.76 | $6.76 | $6.76 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.57 Median $4.57 Typical High $4.57 | Professional | 56 · Pre-op care only | $4.57 | $4.57 | $4.57 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $22.39 Median $22.39 Typical High $22.39 | Professional | 52 · Reduced service | $22.39 | $22.39 | $22.39 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $9.12 Median $9.12 Typical High $9.12 | Professional | 53 · Discontinued | $9.12 | $9.12 | $9.12 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $33.88 Median $33.88 Typical High $33.88 | Professional | 54 · Surgery only | $33.88 | $33.88 | $33.88 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $6.76 Median $6.76 Typical High $6.76 | Professional | 55 · Aftercare only | $6.76 | $6.76 | $6.76 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.57 Median $4.57 Typical High $4.57 | Professional | 56 · Pre-op care only | $4.57 | $4.57 | $4.57 |
Where Maine sits
The same service costs 6.3 times more in North Dakota than in Hawaii. 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· 13th of 51
$126
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.