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 $107.15 Median $165.96 Typical High $165.96 | Professional | None | $107.15 | $165.96 | $165.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $104.71 Median $147.91 Typical High $208.93 | Professional | None | $104.71 | $147.91 | $208.93 |
Cigna Setting Facility Modifier None Typical Low $281.84 Median $630.96 Typical High $2,290.87 | Facility | None | $281.84 | $630.96 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $125.89 Median $154.88 Typical High $239.88 | Professional | None | $125.89 | $154.88 | $239.88 |
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 $107.15 Median $128.82 Typical High $194.98 | Professional | None | $107.15 | $128.82 | $194.98 |
Martin's Point Setting Professional Modifier None Typical Low $109.65 Median $165.96 Typical High $165.96 | Professional | None | $109.65 | $165.96 | $165.96 |
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 $104.71 Median $138.04 Typical High $208.93 | Professional | None | $104.71 | $138.04 | $208.93 |
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 $53.70 Median $83.18 Typical High $83.18 | Professional | 52 · Reduced service | $53.70 | $83.18 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.38 Median $33.11 Typical High $33.11 | Professional | 53 · Discontinued | $21.38 | $33.11 | $33.11 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $125.89 Typical High $125.89 | Professional | 54 · Surgery only | $81.28 | $125.89 | $125.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $25.12 Typical High $25.12 | Professional | 55 · Aftercare only | $16.22 | $25.12 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.72 Median $16.60 Typical High $16.60 | Professional | 56 · Pre-op care only | $10.72 | $16.60 | $16.60 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $54.95 Median $83.18 Typical High $83.18 | Professional | 52 · Reduced service | $54.95 | $83.18 | $83.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $22.39 Median $33.11 Typical High $33.11 | Professional | 53 · Discontinued | $22.39 | $33.11 | $33.11 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $83.18 Median $125.89 Typical High $125.89 | Professional | 54 · Surgery only | $83.18 | $125.89 | $125.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $16.60 Median $25.12 Typical High $25.12 | Professional | 55 · Aftercare only | $16.60 | $25.12 | $25.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $16.60 Typical High $16.60 | Professional | 56 · Pre-op care only | $10.96 | $16.60 | $16.60 |
Where Maine sits
The same service costs 4.8 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· 18th of 51
$155
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.