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 $85.11 Median $87.10 Typical High $123.03 | Professional | None | $85.11 | $87.10 | $123.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $67.61 Median $89.13 Typical High $138.04 | Professional | None | $67.61 | $89.13 | $138.04 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $128.82 Typical High $707.95 | Facility | None | $56.23 | $128.82 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $91.20 Median $128.82 Typical High $162.18 | Professional | None | $91.20 | $128.82 | $162.18 |
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 $74.13 Median $104.71 Typical High $204.17 | Professional | None | $74.13 | $104.71 | $204.17 |
Martin's Point Setting Professional Modifier None Typical Low $87.10 Median $87.10 Typical High $123.03 | Professional | None | $87.10 | $87.10 | $123.03 |
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 $67.61 Median $95.50 Typical High $141.25 | Professional | None | $67.61 | $95.50 | $141.25 |
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 $43.65 Median $43.65 Typical High $61.66 | Professional | 52 · Reduced service | $43.65 | $43.65 | $61.66 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $17.38 Typical High $24.55 | Professional | 53 · Discontinued | $17.38 | $17.38 | $24.55 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $66.07 Median $66.07 Typical High $93.33 | Professional | 54 · Surgery only | $66.07 | $66.07 | $93.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $13.18 Median $13.18 Typical High $18.62 | Professional | 55 · Aftercare only | $13.18 | $13.18 | $18.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $8.71 Typical High $12.30 | Professional | 56 · Pre-op care only | $8.71 | $8.71 | $12.30 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $43.65 Median $43.65 Typical High $61.66 | Professional | 52 · Reduced service | $43.65 | $43.65 | $61.66 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $17.38 Typical High $24.55 | Professional | 53 · Discontinued | $17.38 | $17.38 | $24.55 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $66.07 Median $66.07 Typical High $93.33 | Professional | 54 · Surgery only | $66.07 | $66.07 | $93.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $13.18 Median $13.18 Typical High $18.62 | Professional | 55 · Aftercare only | $13.18 | $13.18 | $18.62 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $8.71 Typical High $12.30 | Professional | 56 · Pre-op care only | $8.71 | $8.71 | $12.30 |
Where Maine sits
The same service costs 3.8 times more in Alaska than in Florida. 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· 29th of 51
$102
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.