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 $53.70 Median $60.26 Typical High $91.20 | Professional | None | $53.70 | $60.26 | $91.20 |
Anthem BCBS Setting Professional Modifier None Typical Low $39.81 Median $79.43 Typical High $141.25 | Professional | None | $39.81 | $79.43 | $141.25 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $87.10 Typical High $707.95 | Facility | None | $56.23 | $87.10 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $56.23 Median $95.50 Typical High $147.91 | Professional | None | $56.23 | $95.50 | $147.91 |
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 $46.77 Median $83.18 Typical High $151.36 | Professional | None | $46.77 | $83.18 | $151.36 |
Martin's Point Setting Professional Modifier None Typical Low $53.70 Median $60.26 Typical High $91.20 | Professional | None | $53.70 | $60.26 | $91.20 |
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 $54.95 Median $83.18 Typical High $125.89 | Professional | None | $54.95 | $83.18 | $125.89 |
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 $26.92 Median $30.20 Typical High $45.71 | Professional | 52 · Reduced service | $26.92 | $30.20 | $45.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.72 Median $12.02 Typical High $18.20 | Professional | 53 · Discontinued | $10.72 | $12.02 | $18.20 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $39.81 Median $44.67 Typical High $67.61 | Professional | 54 · Surgery only | $39.81 | $44.67 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $8.91 Typical High $13.49 | Professional | 55 · Aftercare only | $7.94 | $8.91 | $13.49 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.37 Median $6.03 Typical High $9.12 | Professional | 56 · Pre-op care only | $5.37 | $6.03 | $9.12 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $26.92 Median $30.20 Typical High $45.71 | Professional | 52 · Reduced service | $26.92 | $30.20 | $45.71 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.72 Median $12.02 Typical High $18.20 | Professional | 53 · Discontinued | $10.72 | $12.02 | $18.20 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $39.81 Median $44.67 Typical High $67.61 | Professional | 54 · Surgery only | $39.81 | $44.67 | $67.61 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $8.91 Typical High $13.49 | Professional | 55 · Aftercare only | $7.94 | $8.91 | $13.49 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.37 Median $6.03 Typical High $9.12 | Professional | 56 · Pre-op care only | $5.37 | $6.03 | $9.12 |
Where Maine sits
The same service costs 3.2 times more in Wisconsin than in Kentucky. 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· 33rd of 51
$79.43
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.