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 $51.29 Median $93.33 Typical High $162.18 | Professional | None | $51.29 | $93.33 | $162.18 |
Anthem BCBS Setting Professional Modifier None Typical Low $63.10 Median $117.49 Typical High $257.04 | Professional | None | $63.10 | $117.49 | $257.04 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $151.36 Typical High $707.95 | Facility | None | $56.23 | $151.36 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $69.18 Median $144.54 Typical High $263.03 | Professional | None | $69.18 | $144.54 | $263.03 |
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 $69.18 Median $123.03 Typical High $218.78 | Professional | None | $69.18 | $123.03 | $218.78 |
Martin's Point Setting Professional Modifier None Typical Low $51.29 Median $100.00 Typical High $162.18 | Professional | None | $51.29 | $100.00 | $162.18 |
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 $85.11 Median $123.03 Typical High $218.78 | Professional | None | $85.11 | $123.03 | $218.78 |
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 $25.70 Median $31.62 Typical High $54.95 | Professional | 52 · Reduced service | $25.70 | $31.62 | $54.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $12.59 Typical High $21.88 | Professional | 53 · Discontinued | $10.23 | $12.59 | $21.88 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $47.86 Typical High $83.18 | Professional | 54 · Surgery only | $38.02 | $47.86 | $83.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $9.55 Typical High $16.60 | Professional | 55 · Aftercare only | $7.59 | $9.55 | $16.60 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $6.31 Typical High $10.96 | Professional | 56 · Pre-op care only | $5.13 | $6.31 | $10.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $25.70 Median $31.62 Typical High $54.95 | Professional | 52 · Reduced service | $25.70 | $31.62 | $54.95 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.23 Median $12.59 Typical High $21.88 | Professional | 53 · Discontinued | $10.23 | $12.59 | $21.88 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $38.02 Median $47.86 Typical High $83.18 | Professional | 54 · Surgery only | $38.02 | $47.86 | $83.18 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.59 Median $9.55 Typical High $16.60 | Professional | 55 · Aftercare only | $7.59 | $9.55 | $16.60 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.13 Median $6.31 Typical High $10.96 | Professional | 56 · Pre-op care only | $5.13 | $6.31 | $10.96 |
Where Maine sits
The same service costs 3.2 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· 32nd of 51
$112
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.