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 $37.15 Median $56.23 Typical High $67.61 | Professional | None | $37.15 | $56.23 | $67.61 |
Anthem BCBS Setting Professional Modifier None Typical Low $44.67 Median $79.43 Typical High $151.36 | Professional | None | $44.67 | $79.43 | $151.36 |
Cigna Setting Facility Modifier None Typical Low $56.23 Median $691.83 Typical High $707.95 | Facility | None | $56.23 | $691.83 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $50.12 Median $85.11 Typical High $154.88 | Professional | None | $50.12 | $85.11 | $154.88 |
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 $52.48 Median $89.13 Typical High $162.18 | Professional | None | $52.48 | $89.13 | $162.18 |
Martin's Point Setting Professional Modifier None Typical Low $37.15 Median $57.54 Typical High $74.13 | Professional | None | $37.15 | $57.54 | $74.13 |
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 $60.26 Median $89.13 Typical High $125.89 | Professional | None | $60.26 | $89.13 | $125.89 |
8 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 $18.20 Median $22.91 Typical High $29.51 | Professional | 52 · Reduced service | $18.20 | $22.91 | $29.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $9.12 Typical High $11.75 | Professional | 53 · Discontinued | $7.41 | $9.12 | $11.75 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $6.92 Typical High $8.71 | Professional | 55 · Aftercare only | $5.50 | $6.92 | $8.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.72 Median $4.57 Typical High $5.89 | Professional | 56 · Pre-op care only | $3.72 | $4.57 | $5.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $18.20 Median $22.91 Typical High $29.51 | Professional | 52 · Reduced service | $18.20 | $22.91 | $29.51 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $7.41 Median $9.12 Typical High $11.75 | Professional | 53 · Discontinued | $7.41 | $9.12 | $11.75 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $5.50 Median $6.92 Typical High $8.71 | Professional | 55 · Aftercare only | $5.50 | $6.92 | $8.71 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.72 Median $4.57 Typical High $5.89 | Professional | 56 · Pre-op care only | $3.72 | $4.57 | $5.89 |
Where Maine sits
The same service costs 3.3 times more in Alaska than in New Jersey. 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· 31st of 51
$74.13
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.