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 $47.86 Median $123.03 Typical High $245.47 | Professional | None | $47.86 | $123.03 | $245.47 |
Anthem BCBS Setting Professional Modifier None Typical Low $56.23 Median $134.90 Typical High $251.19 | Professional | None | $56.23 | $134.90 | $251.19 |
Cigna Setting Facility Modifier None Typical Low $131.83 Median $302.00 Typical High $1,412.54 | Facility | None | $131.83 | $302.00 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $63.10 Median $158.49 Typical High $295.12 | Professional | None | $63.10 | $158.49 | $295.12 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $66.07 Median $144.54 Typical High $288.40 | Professional | None | $66.07 | $144.54 | $288.40 |
Martin's Point Setting Professional Modifier None Typical Low $47.86 Median $123.03 Typical High $245.47 | Professional | None | $47.86 | $123.03 | $245.47 |
United Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
United Setting Professional Modifier None Typical Low $79.43 Median $144.54 Typical High $257.04 | Professional | None | $79.43 | $144.54 | $257.04 |
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 $23.44 Median $28.18 Typical High $61.66 | Professional | 52 · Reduced service | $23.44 | $28.18 | $61.66 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.55 Median $11.48 Typical High $24.55 | Professional | 53 · Discontinued | $9.55 | $11.48 | $24.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $42.66 Typical High $91.20 | Professional | 54 · Surgery only | $35.48 | $42.66 | $91.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $8.51 Typical High $18.20 | Professional | 55 · Aftercare only | $7.08 | $8.51 | $18.20 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.79 Median $5.62 Typical High $12.30 | Professional | 56 · Pre-op care only | $4.79 | $5.62 | $12.30 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $23.44 Median $28.18 Typical High $61.66 | Professional | 52 · Reduced service | $23.44 | $28.18 | $61.66 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $9.55 Median $11.48 Typical High $24.55 | Professional | 53 · Discontinued | $9.55 | $11.48 | $24.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $35.48 Median $42.66 Typical High $91.20 | Professional | 54 · Surgery only | $35.48 | $42.66 | $91.20 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.08 Median $8.51 Typical High $18.20 | Professional | 55 · Aftercare only | $7.08 | $8.51 | $18.20 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.79 Median $5.62 Typical High $12.30 | Professional | 56 · Pre-op care only | $4.79 | $5.62 | $12.30 |
Where Maine sits
The same service costs 2.6 times more in Alaska than in Montana. 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· 45th of 51
$123
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.