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 $57.54 Median $123.03 Typical High $199.53 | Professional | None | $57.54 | $123.03 | $199.53 |
Anthem BCBS Setting Professional Modifier None Typical Low $54.95 Median $112.20 Typical High $245.47 | Professional | None | $54.95 | $112.20 | $245.47 |
Cigna Setting Facility Modifier None Typical Low $134.90 Median $309.03 Typical High $1,412.54 | Facility | None | $134.90 | $309.03 | $1,412.54 |
Cigna Setting Professional Modifier None Typical Low $69.18 Median $134.90 Typical High $251.19 | Professional | None | $69.18 | $134.90 | $251.19 |
Harvard Pilgrim Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $56.23 Median $117.49 Typical High $263.03 | Professional | None | $56.23 | $117.49 | $263.03 |
Martin's Point Setting Professional Modifier None Typical Low $57.54 Median $120.23 Typical High $199.53 | Professional | None | $57.54 | $120.23 | $199.53 |
United Setting Facility Modifier None Typical Low $416.87 Median $741.31 Typical High $1,202.26 | Facility | None | $416.87 | $741.31 | $1,202.26 |
United Setting Professional Modifier None Typical Low $48.98 Median $107.15 Typical High $204.17 | Professional | None | $48.98 | $107.15 | $204.17 |
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 $28.84 Median $54.95 Typical High $74.13 | Professional | 52 · Reduced service | $28.84 | $54.95 | $74.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $21.88 Typical High $30.20 | Professional | 53 · Discontinued | $11.48 | $21.88 | $30.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $43.65 Median $81.28 Typical High $112.20 | Professional | 54 · Surgery only | $43.65 | $81.28 | $112.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.71 Median $16.22 Typical High $22.39 | Professional | 55 · Aftercare only | $8.71 | $16.22 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $10.96 Typical High $15.14 | Professional | 56 · Pre-op care only | $5.75 | $10.96 | $15.14 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $28.84 Median $54.95 Typical High $74.13 | Professional | 52 · Reduced service | $28.84 | $54.95 | $74.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $21.88 Typical High $30.20 | Professional | 53 · Discontinued | $11.48 | $21.88 | $30.20 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $43.65 Median $81.28 Typical High $112.20 | Professional | 54 · Surgery only | $43.65 | $81.28 | $112.20 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $8.71 Median $16.22 Typical High $22.39 | Professional | 55 · Aftercare only | $8.71 | $16.22 | $22.39 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $10.96 Typical High $15.14 | Professional | 56 · Pre-op care only | $5.75 | $10.96 | $15.14 |
Where Maine sits
The same service costs 3.5 times more in Alaska than in Washington, DC. 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· 27th of 51
$117
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.