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 $100.00 Median $190.55 Typical High $218.78 | Professional | None | $100.00 | $190.55 | $218.78 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,023.29 Median $1,023.29 Typical High $1,023.29 | Facility | None | $1,023.29 | $1,023.29 | $1,023.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $97.72 Median $181.97 Typical High $338.84 | Professional | None | $97.72 | $181.97 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $537.03 Median $1,584.89 Typical High $2,570.40 | Facility | None | $537.03 | $1,584.89 | $2,570.40 |
Cigna Setting Professional Modifier None Typical Low $114.82 Median $204.17 Typical High $380.19 | Professional | None | $114.82 | $204.17 | $380.19 |
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 $100.00 Median $181.97 Typical High $416.87 | Professional | None | $100.00 | $181.97 | $416.87 |
Martin's Point Setting Professional Modifier None Typical Low $100.00 Median $190.55 Typical High $218.78 | Professional | None | $100.00 | $190.55 | $218.78 |
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 $85.11 Median $173.78 Typical High $354.81 | Professional | None | $85.11 | $173.78 | $354.81 |
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 $50.12 Median $95.50 Typical High $109.65 | Professional | 52 · Reduced service | $50.12 | $95.50 | $109.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $38.02 Typical High $44.67 | Professional | 53 · Discontinued | $19.95 | $38.02 | $44.67 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $141.25 Typical High $165.96 | Professional | 54 · Surgery only | $75.86 | $141.25 | $165.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $28.18 Typical High $33.11 | Professional | 55 · Aftercare only | $15.14 | $28.18 | $33.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $19.05 Typical High $21.88 | Professional | 56 · Pre-op care only | $10.00 | $19.05 | $21.88 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $50.12 Median $95.50 Typical High $109.65 | Professional | 52 · Reduced service | $50.12 | $95.50 | $109.65 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $38.02 Typical High $44.67 | Professional | 53 · Discontinued | $19.95 | $38.02 | $44.67 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $75.86 Median $141.25 Typical High $165.96 | Professional | 54 · Surgery only | $75.86 | $141.25 | $165.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $28.18 Typical High $33.11 | Professional | 55 · Aftercare only | $15.14 | $28.18 | $33.11 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $19.05 Typical High $21.88 | Professional | 56 · Pre-op care only | $10.00 | $19.05 | $21.88 |
Where Maine sits
The same service costs 4.5 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
$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.