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 $95.50 Median $112.20 Typical High $234.42 | Professional | None | $95.50 | $112.20 | $234.42 |
Anthem BCBS Setting Professional Modifier None Typical Low $85.11 Median $177.83 Typical High $338.84 | Professional | None | $85.11 | $177.83 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $162.18 Median $363.08 Typical High $2,290.87 | Facility | None | $162.18 | $363.08 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $223.87 Typical High $371.54 | Professional | None | $114.82 | $223.87 | $371.54 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $85.11 Median $181.97 Typical High $371.54 | Professional | None | $85.11 | $181.97 | $371.54 |
Martin's Point Setting Professional Modifier None Typical Low $97.72 Median $112.20 Typical High $234.42 | Professional | None | $97.72 | $112.20 | $234.42 |
United Setting Facility Modifier None Typical Low $933.25 Median $1,258.93 Typical High $1,584.89 | Facility | None | $933.25 | $1,258.93 | $1,584.89 |
United Setting Professional Modifier None Typical Low $83.18 Median $181.97 Typical High $316.23 | Professional | None | $83.18 | $181.97 | $316.23 |
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 $47.86 Median $56.23 Typical High $117.49 | Professional | 52 · Reduced service | $47.86 | $56.23 | $117.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.05 Median $22.39 Typical High $46.77 | Professional | 53 · Discontinued | $19.05 | $22.39 | $46.77 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $72.44 Median $83.18 Typical High $173.78 | Professional | 54 · Surgery only | $72.44 | $83.18 | $173.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $14.45 Median $16.98 Typical High $34.67 | Professional | 55 · Aftercare only | $14.45 | $16.98 | $34.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $9.55 Median $11.22 Typical High $23.44 | Professional | 56 · Pre-op care only | $9.55 | $11.22 | $23.44 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $50.12 Median $56.23 Typical High $117.49 | Professional | 52 · Reduced service | $50.12 | $56.23 | $117.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $22.39 Typical High $46.77 | Professional | 53 · Discontinued | $19.95 | $22.39 | $46.77 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $74.13 Median $83.18 Typical High $173.78 | Professional | 54 · Surgery only | $74.13 | $83.18 | $173.78 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $14.79 Median $16.98 Typical High $34.67 | Professional | 55 · Aftercare only | $14.79 | $16.98 | $34.67 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $11.22 Typical High $23.44 | Professional | 56 · Pre-op care only | $10.00 | $11.22 | $23.44 |
Where Maine sits
The same service costs 3.7 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· 24th of 51
$186
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.