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 $125.89 Median $263.03 Typical High $263.03 | Professional | None | $125.89 | $263.03 | $263.03 |
Anthem BCBS Setting Professional Modifier None Typical Low $162.18 Median $234.42 Typical High $338.84 | Professional | None | $162.18 | $234.42 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $281.84 Median $457.09 Typical High $1,412.54 | Facility | None | $281.84 | $457.09 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $190.55 Median $251.19 Typical High $371.54 | Professional | None | $190.55 | $251.19 | $371.54 |
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 $158.49 Median $177.83 Typical High $316.23 | Professional | None | $158.49 | $177.83 | $316.23 |
Martin's Point Setting Professional Modifier None Typical Low $173.78 Median $263.03 Typical High $263.03 | Professional | None | $173.78 | $263.03 | $263.03 |
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 $147.91 Median $177.83 Typical High $338.84 | Professional | None | $147.91 | $177.83 | $338.84 |
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 $63.10 Median $131.83 Typical High $131.83 | Professional | 52 · Reduced service | $63.10 | $131.83 | $131.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $52.48 Typical High $52.48 | Professional | 53 · Discontinued | $25.12 | $52.48 | $52.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $93.33 Median $194.98 Typical High $194.98 | Professional | 54 · Surgery only | $93.33 | $194.98 | $194.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $39.81 Typical High $39.81 | Professional | 55 · Aftercare only | $18.62 | $39.81 | $39.81 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $26.30 Typical High $26.30 | Professional | 56 · Pre-op care only | $12.59 | $26.30 | $26.30 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $87.10 Median $131.83 Typical High $131.83 | Professional | 52 · Reduced service | $87.10 | $131.83 | $131.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $35.48 Median $52.48 Typical High $52.48 | Professional | 53 · Discontinued | $35.48 | $52.48 | $52.48 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $131.83 Median $194.98 Typical High $194.98 | Professional | 54 · Surgery only | $131.83 | $194.98 | $194.98 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $39.81 Typical High $39.81 | Professional | 55 · Aftercare only | $26.30 | $39.81 | $39.81 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $26.30 Typical High $26.30 | Professional | 56 · Pre-op care only | $17.38 | $26.30 | $26.30 |
Where Maine sits
The same service costs 4.6 times more in Alaska than in Utah. 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· 17th 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.