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 $39.81 Median $47.86 Typical High $6,025.60 | Facility | None | $39.81 | $47.86 | $6,025.60 |
Aetna Setting Professional Modifier None Typical Low $39.81 Median $47.86 Typical High $100.00 | Professional | None | $39.81 | $47.86 | $100.00 |
Anthem BCBS Setting Professional Modifier None Typical Low $45.71 Median $69.18 Typical High $114.82 | Professional | None | $45.71 | $69.18 | $114.82 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $707.95 Typical High $2,290.87 | Facility | None | $691.83 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $69.18 Median $89.13 Typical High $114.82 | Professional | None | $69.18 | $89.13 | $114.82 |
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 $53.70 Median $81.28 Typical High $117.49 | Professional | None | $53.70 | $81.28 | $117.49 |
Martin's Point Setting Facility Modifier None Typical Low $6,025.60 Median $6,025.60 Typical High $8,511.38 | Facility | None | $6,025.60 | $6,025.60 | $8,511.38 |
Martin's Point Setting Professional Modifier None Typical Low $39.81 Median $47.86 Typical High $100.00 | Professional | None | $39.81 | $47.86 | $100.00 |
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 $60.26 Median $85.11 Typical High $114.82 | Professional | None | $60.26 | $85.11 | $114.82 |
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 $19.95 Median $23.99 Typical High $23.99 | Professional | 52 · Reduced service | $19.95 | $23.99 | $23.99 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $9.55 Typical High $9.55 | Professional | 53 · Discontinued | $7.94 | $9.55 | $9.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $29.51 Median $35.48 Typical High $35.48 | Professional | 54 · Surgery only | $29.51 | $35.48 | $35.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.89 Median $7.08 Typical High $7.08 | Professional | 55 · Aftercare only | $5.89 | $7.08 | $7.08 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.98 Median $4.79 Typical High $4.79 | Professional | 56 · Pre-op care only | $3.98 | $4.79 | $4.79 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $19.95 Median $23.99 Typical High $23.99 | Professional | 52 · Reduced service | $19.95 | $23.99 | $23.99 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $9.55 Typical High $9.55 | Professional | 53 · Discontinued | $7.94 | $9.55 | $9.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $29.51 Median $35.48 Typical High $35.48 | Professional | 54 · Surgery only | $29.51 | $35.48 | $35.48 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $5.89 Median $7.08 Typical High $7.08 | Professional | 55 · Aftercare only | $5.89 | $7.08 | $7.08 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.98 Median $4.79 Typical High $4.79 | Professional | 56 · Pre-op care only | $3.98 | $4.79 | $4.79 |
Where Maine sits
The same service costs 4.8 times more in Alaska 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· 25th of 51
$74.13
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.