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 $199.53 Median $199.53 Typical High $309.03 | Professional | None | $199.53 | $199.53 | $309.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $154.88 Median $213.80 Typical High $316.23 | Professional | None | $154.88 | $213.80 | $316.23 |
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 $204.17 Median $309.03 Typical High $389.05 | Professional | None | $204.17 | $309.03 | $389.05 |
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 $275.42 Typical High $512.86 | Professional | None | $177.83 | $275.42 | $512.86 |
Martin's Point Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $309.03 | Professional | None | $199.53 | $199.53 | $309.03 |
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 $158.49 Median $245.47 Typical High $407.38 | Professional | None | $158.49 | $245.47 | $407.38 |
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 $154.88 | Professional | 52 · Reduced service | $100.00 | $100.00 | $154.88 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $39.81 Typical High $61.66 | Professional | 53 · Discontinued | $39.81 | $39.81 | $61.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $147.91 Typical High $229.09 | Professional | 54 · Surgery only | $147.91 | $147.91 | $229.09 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $29.51 Typical High $45.71 | Professional | 55 · Aftercare only | $29.51 | $29.51 | $45.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $19.95 Typical High $30.90 | Professional | 56 · Pre-op care only | $19.95 | $19.95 | $30.90 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $100.00 Median $100.00 Typical High $154.88 | Professional | 52 · Reduced service | $100.00 | $100.00 | $154.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $39.81 Median $39.81 Typical High $61.66 | Professional | 53 · Discontinued | $39.81 | $39.81 | $61.66 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $147.91 Median $147.91 Typical High $229.09 | Professional | 54 · Surgery only | $147.91 | $147.91 | $229.09 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $29.51 Median $29.51 Typical High $45.71 | Professional | 55 · Aftercare only | $29.51 | $29.51 | $45.71 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.95 Median $19.95 Typical High $30.90 | Professional | 56 · Pre-op care only | $19.95 | $19.95 | $30.90 |
Where Maine sits
The same service costs 3.9 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· 32nd of 51
$240
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.