How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). 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 $13.49 Median $15.49 Typical High $25.12 | Professional | None | $13.49 | $15.49 | $25.12 |
Anthem BCBS Setting Professional Modifier None Typical Low $9.77 Median $16.60 Typical High $33.11 | Professional | None | $9.77 | $16.60 | $33.11 |
Cigna Setting Professional Modifier None Typical Low $12.02 Median $22.39 Typical High $34.67 | Professional | None | $12.02 | $22.39 | $34.67 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $10.96 Median $17.38 Typical High $34.67 | Professional | None | $10.96 | $17.38 | $34.67 |
Martin's Point Setting Professional Modifier None Typical Low $13.49 Median $15.49 Typical High $25.12 | Professional | None | $13.49 | $15.49 | $25.12 |
United Setting Professional Modifier None Typical Low $11.48 Median $17.38 Typical High $28.18 | Professional | None | $11.48 | $17.38 | $28.18 |
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 $6.61 Median $6.61 Typical High $12.59 | Professional | 52 · Reduced service | $6.61 | $6.61 | $12.59 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $2.69 Median $2.69 Typical High $5.01 | Professional | 53 · Discontinued | $2.69 | $2.69 | $5.01 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.00 Median $2.00 Typical High $3.80 | Professional | 55 · Aftercare only | $2.00 | $2.00 | $3.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.35 Median $1.35 Typical High $2.51 | Professional | 56 · Pre-op care only | $1.35 | $1.35 | $2.51 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $6.61 Median $6.61 Typical High $12.59 | Professional | 52 · Reduced service | $6.61 | $6.61 | $12.59 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $2.69 Median $2.69 Typical High $5.01 | Professional | 53 · Discontinued | $2.69 | $2.69 | $5.01 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.00 Median $2.00 Typical High $3.80 | Professional | 55 · Aftercare only | $2.00 | $2.00 | $3.80 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.35 Median $1.35 Typical High $2.51 | Professional | 56 · Pre-op care only | $1.35 | $1.35 | $2.51 |
Where Maine sits
The same service costs 3.2 times more in Wisconsin than in Nebraska. 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· 39th of 51
$16.98
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.