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 $173.78 Median $213.80 Typical High $213.80 | Professional | None | $173.78 | $213.80 | $213.80 |
Anthem BCBS Setting Professional Modifier None Typical Low $173.78 Median $223.87 Typical High $338.84 | Professional | None | $173.78 | $223.87 | $338.84 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $707.95 Typical High $2,290.87 | Facility | None | $616.60 | $707.95 | $2,290.87 |
Cigna Setting Professional Modifier None Typical Low $208.93 Median $218.78 Typical High $363.08 | Professional | None | $208.93 | $218.78 | $363.08 |
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 $177.83 Median $194.98 Typical High $302.00 | Professional | None | $177.83 | $194.98 | $302.00 |
Martin's Point Setting Professional Modifier None Typical Low $204.17 Median $213.80 Typical High $213.80 | Professional | None | $204.17 | $213.80 | $213.80 |
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 $158.49 Median $199.53 Typical High $288.40 | Professional | None | $158.49 | $199.53 | $288.40 |
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 $87.10 Median $107.15 Typical High $107.15 | Professional | 52 · Reduced service | $87.10 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $42.66 Typical High $42.66 | Professional | 53 · Discontinued | $34.67 | $42.66 | $42.66 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $158.49 Typical High $158.49 | Professional | 54 · Surgery only | $128.82 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $31.62 Typical High $31.62 | Professional | 55 · Aftercare only | $25.70 | $31.62 | $31.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $21.38 Typical High $21.38 | Professional | 56 · Pre-op care only | $17.38 | $21.38 | $21.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $102.33 Median $107.15 Typical High $107.15 | Professional | 52 · Reduced service | $102.33 | $107.15 | $107.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $42.66 Typical High $42.66 | Professional | 53 · Discontinued | $40.74 | $42.66 | $42.66 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $154.88 Median $158.49 Typical High $158.49 | Professional | 54 · Surgery only | $154.88 | $158.49 | $158.49 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $31.62 Typical High $31.62 | Professional | 55 · Aftercare only | $30.90 | $31.62 | $31.62 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $21.38 Typical High $21.38 | Professional | 56 · Pre-op care only | $20.42 | $21.38 | $21.38 |
Where Maine sits
The same service costs 4.5 times more in Alaska than in New York. 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· 36th of 51
$214
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.