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 $13.18 Median $13.18 Typical High $29.51 | Facility | None | $13.18 | $13.18 | $29.51 |
Aetna Setting Professional Modifier None Typical Low $13.18 Median $25.12 Typical High $53.70 | Professional | None | $13.18 | $25.12 | $53.70 |
Anthem BCBS Setting Professional Modifier None Typical Low $13.49 Median $30.90 Typical High $61.66 | Professional | None | $13.49 | $30.90 | $61.66 |
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 $16.22 Median $33.88 Typical High $64.57 | Professional | None | $16.22 | $33.88 | $64.57 |
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 $18.20 Median $31.62 Typical High $57.54 | Professional | None | $18.20 | $31.62 | $57.54 |
Martin's Point Setting Professional Modifier None Typical Low $13.18 Median $26.30 Typical High $53.70 | Professional | None | $13.18 | $26.30 | $53.70 |
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 $19.50 Median $31.62 Typical High $53.70 | Professional | None | $19.50 | $31.62 | $53.70 |
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 $6.61 Median $6.61 Typical High $14.79 | Professional | 52 · Reduced service | $6.61 | $6.61 | $14.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.63 Median $2.69 Typical High $5.89 | Professional | 53 · Discontinued | $2.63 | $2.69 | $5.89 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $9.77 Median $10.00 Typical High $22.39 | Professional | 54 · Surgery only | $9.77 | $10.00 | $22.39 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.00 Median $2.00 Typical High $4.47 | Professional | 55 · Aftercare only | $2.00 | $2.00 | $4.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.32 Median $1.35 Typical High $2.95 | Professional | 56 · Pre-op care only | $1.32 | $1.35 | $2.95 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $6.61 Median $6.61 Typical High $14.79 | Professional | 52 · Reduced service | $6.61 | $6.61 | $14.79 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.63 Median $2.63 Typical High $5.89 | Professional | 53 · Discontinued | $2.63 | $2.63 | $5.89 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $9.77 Median $9.77 Typical High $22.39 | Professional | 54 · Surgery only | $9.77 | $9.77 | $22.39 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.00 Median $2.00 Typical High $4.47 | Professional | 55 · Aftercare only | $2.00 | $2.00 | $4.47 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.32 Median $1.32 Typical High $2.95 | Professional | 56 · Pre-op care only | $1.32 | $1.32 | $2.95 |
Where Maine sits
The same service costs 3.5 times more in Alaska than in New Jersey. 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· 40th of 51
$29.51
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.