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 $199.53 Median $199.53 Typical High $338.84 | Facility | None | $199.53 | $199.53 | $338.84 |
Aetna Setting Professional Modifier None Typical Low $199.53 Median $269.15 Typical High $338.84 | Professional | None | $199.53 | $269.15 | $338.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $158.49 Median $223.87 Typical High $323.59 | Professional | None | $158.49 | $223.87 | $323.59 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $251.19 Typical High $707.95 | Facility | None | $56.23 | $251.19 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $218.78 Median $316.23 Typical High $436.52 | Professional | None | $218.78 | $316.23 | $436.52 |
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 $177.83 Median $288.40 Typical High $575.44 | Professional | None | $177.83 | $288.40 | $575.44 |
Martin's Point Setting Professional Modifier None Typical Low $199.53 Median $295.12 Typical High $338.84 | Professional | None | $199.53 | $295.12 | $338.84 |
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 $154.88 Median $251.19 Typical High $398.11 | Professional | None | $154.88 | $251.19 | $398.11 |
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 $100.00 Median $100.00 Typical High $169.82 | Professional | 52 · Reduced service | $100.00 | $100.00 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $39.81 Typical High $67.61 | Professional | 53 · Discontinued | $39.81 | $39.81 | $67.61 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $151.36 Median $151.36 Typical High $251.19 | Professional | 54 · Surgery only | $151.36 | $151.36 | $251.19 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.20 Median $30.20 Typical High $51.29 | Professional | 55 · Aftercare only | $30.20 | $30.20 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $19.95 Typical High $33.88 | Professional | 56 · Pre-op care only | $19.95 | $19.95 | $33.88 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $100.00 Median $100.00 Typical High $169.82 | Professional | 52 · Reduced service | $100.00 | $100.00 | $169.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $39.81 Typical High $67.61 | Professional | 53 · Discontinued | $39.81 | $39.81 | $67.61 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $151.36 Median $151.36 Typical High $251.19 | Professional | 54 · Surgery only | $151.36 | $151.36 | $251.19 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $30.20 Median $30.20 Typical High $51.29 | Professional | 55 · Aftercare only | $30.20 | $30.20 | $51.29 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $19.95 Typical High $33.88 | Professional | 56 · Pre-op care only | $19.95 | $19.95 | $33.88 |
Where Maine sits
The same service costs 3.6 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· 36th of 51
$251
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.