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 $75.86 Median $75.86 Typical High $125.89 | Facility | None | $75.86 | $75.86 | $125.89 |
Aetna Setting Professional Modifier None Typical Low $75.86 Median $125.89 Typical High $263.03 | Professional | None | $75.86 | $125.89 | $263.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $93.33 Median $158.49 Typical High $302.00 | Professional | None | $93.33 | $158.49 | $302.00 |
Cigna Setting Facility Modifier None Typical Low $109.65 Median $245.47 Typical High $1,412.54 | Facility | None | $109.65 | $245.47 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $181.97 Typical High $309.03 | Professional | None | $104.71 | $181.97 | $309.03 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $120.23 Median $186.21 Typical High $309.03 | Professional | None | $120.23 | $186.21 | $309.03 |
Martin's Point Setting Professional Modifier None Typical Low $75.86 Median $125.89 Typical High $263.03 | Professional | None | $75.86 | $125.89 | $263.03 |
United Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
United Setting Professional Modifier None Typical Low $125.89 Median $186.21 Typical High $269.15 | Professional | None | $125.89 | $186.21 | $269.15 |
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 $38.02 Median $46.77 Typical High $63.10 | Professional | 52 · Reduced service | $38.02 | $46.77 | $63.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.49 Median $18.62 Typical High $25.12 | Professional | 53 · Discontinued | $15.49 | $18.62 | $25.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $70.79 Typical High $95.50 | Professional | 54 · Surgery only | $57.54 | $70.79 | $95.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $14.13 Typical High $19.05 | Professional | 55 · Aftercare only | $11.48 | $14.13 | $19.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $9.33 Typical High $12.59 | Professional | 56 · Pre-op care only | $7.59 | $9.33 | $12.59 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $38.02 Median $46.77 Typical High $63.10 | Professional | 52 · Reduced service | $38.02 | $46.77 | $63.10 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $15.49 Median $18.62 Typical High $25.12 | Professional | 53 · Discontinued | $15.49 | $18.62 | $25.12 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $70.79 Typical High $95.50 | Professional | 54 · Surgery only | $57.54 | $70.79 | $95.50 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $14.13 Typical High $19.05 | Professional | 55 · Aftercare only | $11.48 | $14.13 | $19.05 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $9.33 Typical High $12.59 | Professional | 56 · Pre-op care only | $7.59 | $9.33 | $12.59 |
Where Maine sits
The same service costs 3.2 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· 38th of 51
$151
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.