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 $131.83 Median $158.49 Typical High $223.87 | Professional | None | $131.83 | $158.49 | $223.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $117.49 Median $173.78 Typical High $251.19 | Professional | None | $117.49 | $173.78 | $251.19 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $107.15 Typical High $707.95 | Facility | None | $56.23 | $107.15 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $141.25 Median $173.78 Typical High $302.00 | Professional | None | $141.25 | $173.78 | $302.00 |
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 $147.91 Median $213.80 Typical High $302.00 | Professional | None | $147.91 | $213.80 | $302.00 |
Martin's Point Setting Professional Modifier None Typical Low $134.90 Median $158.49 Typical High $223.87 | Professional | None | $134.90 | $158.49 | $223.87 |
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 $158.49 Median $213.80 Typical High $281.84 | Professional | None | $158.49 | $213.80 | $281.84 |
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 $74.13 Median $74.13 Typical High $87.10 | Professional | 52 · Reduced service | $74.13 | $74.13 | $87.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $29.51 Median $29.51 Typical High $35.48 | Professional | 53 · Discontinued | $29.51 | $29.51 | $35.48 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $109.65 Typical High $131.83 | Professional | 54 · Surgery only | $109.65 | $109.65 | $131.83 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $22.39 Typical High $26.30 | Professional | 55 · Aftercare only | $22.39 | $22.39 | $26.30 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.79 Median $14.79 Typical High $17.38 | Professional | 56 · Pre-op care only | $14.79 | $14.79 | $17.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $74.13 Median $74.13 Typical High $87.10 | Professional | 52 · Reduced service | $74.13 | $74.13 | $87.10 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $29.51 Median $29.51 Typical High $35.48 | Professional | 53 · Discontinued | $29.51 | $29.51 | $35.48 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $109.65 Median $109.65 Typical High $131.83 | Professional | 54 · Surgery only | $109.65 | $109.65 | $131.83 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $22.39 Median $22.39 Typical High $26.30 | Professional | 55 · Aftercare only | $22.39 | $22.39 | $26.30 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.79 Median $14.79 Typical High $17.38 | Professional | 56 · Pre-op care only | $14.79 | $14.79 | $17.38 |
Where Maine sits
The same service costs 2.9 times more in Alaska 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· 32nd of 51
$178
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.