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 $218.78 Median $218.78 Typical High $363.08 | Professional | None | $218.78 | $218.78 | $363.08 |
Anthem BCBS Setting Professional Modifier None Typical Low $173.78 Median $239.88 Typical High $346.74 | Professional | None | $173.78 | $239.88 | $346.74 |
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 $223.87 Median $338.84 Typical High $467.74 | Professional | None | $223.87 | $338.84 | $467.74 |
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 $181.97 Median $288.40 Typical High $616.60 | Professional | None | $181.97 | $288.40 | $616.60 |
Martin's Point Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $363.08 | Professional | None | $218.78 | $218.78 | $363.08 |
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 $165.96 Median $245.47 Typical High $380.19 | Professional | None | $165.96 | $245.47 | $380.19 |
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 $107.15 Median $107.15 Typical High $181.97 | Professional | 52 · Reduced service | $107.15 | $107.15 | $181.97 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $43.65 Typical High $72.44 | Professional | 53 · Discontinued | $43.65 | $43.65 | $72.44 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $162.18 Median $162.18 Typical High $269.15 | Professional | 54 · Surgery only | $162.18 | $162.18 | $269.15 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $32.36 Typical High $54.95 | Professional | 55 · Aftercare only | $32.36 | $32.36 | $54.95 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $21.88 Typical High $36.31 | Professional | 56 · Pre-op care only | $21.88 | $21.88 | $36.31 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $107.15 Median $107.15 Typical High $181.97 | Professional | 52 · Reduced service | $107.15 | $107.15 | $181.97 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $43.65 Median $43.65 Typical High $72.44 | Professional | 53 · Discontinued | $43.65 | $43.65 | $72.44 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $162.18 Median $162.18 Typical High $269.15 | Professional | 54 · Surgery only | $162.18 | $162.18 | $269.15 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $32.36 Median $32.36 Typical High $54.95 | Professional | 55 · Aftercare only | $32.36 | $32.36 | $54.95 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $21.88 Median $21.88 Typical High $36.31 | Professional | 56 · Pre-op care only | $21.88 | $21.88 | $36.31 |
Where Maine sits
The same service costs 4.0 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· 30th of 51
$263
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.