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 Facility Modifier None Typical Low $26.92 Median $26.92 Typical High $54.95 | Facility | None | $26.92 | $26.92 | $54.95 |
Aetna Setting Professional Modifier None Typical Low $26.92 Median $34.67 Typical High $54.95 | Professional | None | $26.92 | $34.67 | $54.95 |
Anthem BCBS Setting Professional Modifier None Typical Low $24.55 Median $48.98 Typical High $107.15 | Professional | None | $24.55 | $48.98 | $107.15 |
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 $35.48 Median $60.26 Typical High $109.65 | Professional | None | $35.48 | $60.26 | $109.65 |
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 $28.84 Median $54.95 Typical High $100.00 | Professional | None | $28.84 | $54.95 | $100.00 |
Martin's Point Setting Professional Modifier None Typical Low $26.92 Median $34.67 Typical High $54.95 | Professional | None | $26.92 | $34.67 | $54.95 |
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 $38.02 Median $52.48 Typical High $91.20 | Professional | None | $38.02 | $52.48 | $91.20 |
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 $13.49 Median $15.85 Typical High $27.54 | Professional | 52 · Reduced service | $13.49 | $15.85 | $27.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.37 Median $6.31 Typical High $10.96 | Professional | 53 · Discontinued | $5.37 | $6.31 | $10.96 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.07 Median $4.79 Typical High $8.13 | Professional | 55 · Aftercare only | $4.07 | $4.79 | $8.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.69 Median $3.16 Typical High $5.50 | Professional | 56 · Pre-op care only | $2.69 | $3.16 | $5.50 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $13.49 Median $15.85 Typical High $27.54 | Professional | 52 · Reduced service | $13.49 | $15.85 | $27.54 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $5.37 Median $6.31 Typical High $10.96 | Professional | 53 · Discontinued | $5.37 | $6.31 | $10.96 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $4.07 Median $4.79 Typical High $8.13 | Professional | 55 · Aftercare only | $4.07 | $4.79 | $8.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.69 Median $3.16 Typical High $5.50 | Professional | 56 · Pre-op care only | $2.69 | $3.16 | $5.50 |
Where Maine sits
The same service costs 3.5 times more in Wisconsin than in Utah. 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· 40th of 51
$53.70
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.