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 $66.07 Median $83.18 Typical High $141.25 | Professional | None | $66.07 | $83.18 | $141.25 |
Anthem BCBS Setting Professional Modifier None Typical Low $50.12 Median $87.10 Typical High $162.18 | Professional | None | $50.12 | $87.10 | $162.18 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $707.95 Typical High $2,290.87 | Facility | None | $691.83 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $77.62 Median $114.82 Typical High $165.96 | Professional | None | $77.62 | $114.82 | $165.96 |
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 $66.07 Median $104.71 Typical High $162.18 | Professional | None | $66.07 | $104.71 | $162.18 |
Martin's Point Setting Professional Modifier None Typical Low $64.57 Median $83.18 Typical High $141.25 | Professional | None | $64.57 | $83.18 | $141.25 |
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 $74.13 Median $104.71 Typical High $151.36 | Professional | None | $74.13 | $104.71 | $151.36 |
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 $41.69 Median $41.69 Typical High $63.10 | Professional | 52 · Reduced service | $41.69 | $41.69 | $63.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $16.60 Typical High $25.12 | Professional | 53 · Discontinued | $16.60 | $16.60 | $25.12 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $61.66 Typical High $95.50 | Professional | 54 · Surgery only | $61.66 | $61.66 | $95.50 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $12.30 Typical High $19.05 | Professional | 55 · Aftercare only | $12.30 | $12.30 | $19.05 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $8.32 Typical High $12.59 | Professional | 56 · Pre-op care only | $8.32 | $8.32 | $12.59 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $41.69 Median $41.69 Typical High $63.10 | Professional | 52 · Reduced service | $41.69 | $41.69 | $63.10 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $16.60 Median $16.60 Typical High $25.12 | Professional | 53 · Discontinued | $16.60 | $16.60 | $25.12 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $61.66 Median $61.66 Typical High $95.50 | Professional | 54 · Surgery only | $61.66 | $61.66 | $95.50 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $12.30 Median $12.30 Typical High $19.05 | Professional | 55 · Aftercare only | $12.30 | $12.30 | $19.05 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.32 Median $8.32 Typical High $12.59 | Professional | 56 · Pre-op care only | $8.32 | $8.32 | $12.59 |
Where Maine sits
The same service costs 3.7 times more in Wisconsin 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· 37th of 51
$97.72
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.