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 $57.54 Median $112.20 Typical High $177.83 | Professional | None | $57.54 | $112.20 | $177.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $72.44 Median $134.90 Typical High $281.84 | Professional | None | $72.44 | $134.90 | $281.84 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $77.62 Median $162.18 Typical High $288.40 | Professional | None | $77.62 | $162.18 | $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 $81.28 Median $147.91 Typical High $275.42 | Professional | None | $81.28 | $147.91 | $275.42 |
Martin's Point Setting Professional Modifier None Typical Low $57.54 Median $114.82 Typical High $204.17 | Professional | None | $57.54 | $114.82 | $204.17 |
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 $95.50 Median $141.25 Typical High $257.04 | Professional | None | $95.50 | $141.25 | $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 $28.84 Median $36.31 Typical High $61.66 | Professional | 52 · Reduced service | $28.84 | $36.31 | $61.66 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $14.45 Typical High $24.55 | Professional | 53 · Discontinued | $11.48 | $14.45 | $24.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $43.65 Median $53.70 Typical High $93.33 | Professional | 54 · Surgery only | $43.65 | $53.70 | $93.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.71 Median $10.72 Typical High $18.62 | Professional | 55 · Aftercare only | $8.71 | $10.72 | $18.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $7.24 Typical High $12.30 | Professional | 56 · Pre-op care only | $5.75 | $7.24 | $12.30 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $28.84 Median $36.31 Typical High $61.66 | Professional | 52 · Reduced service | $28.84 | $36.31 | $61.66 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $14.45 Typical High $24.55 | Professional | 53 · Discontinued | $11.48 | $14.45 | $24.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $43.65 Median $53.70 Typical High $93.33 | Professional | 54 · Surgery only | $43.65 | $53.70 | $93.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $8.71 Median $10.72 Typical High $18.62 | Professional | 55 · Aftercare only | $8.71 | $10.72 | $18.62 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $7.24 Typical High $12.30 | Professional | 56 · Pre-op care only | $5.75 | $7.24 | $12.30 |
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· 38th 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.