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 $47.86 Median $61.66 Typical High $70.79 | Professional | None | $47.86 | $61.66 | $70.79 |
Anthem BCBS Setting Professional Modifier None Typical Low $45.71 Median $79.43 Typical High $144.54 | Professional | None | $45.71 | $79.43 | $144.54 |
Cigna Setting Facility Modifier None Typical Low $43.65 Median $61.66 Typical High $707.95 | Facility | None | $43.65 | $61.66 | $707.95 |
Cigna Setting Professional Modifier None Typical Low $64.57 Median $102.33 Typical High $147.91 | Professional | None | $64.57 | $102.33 | $147.91 |
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 $51.29 Median $81.28 Typical High $138.04 | Professional | None | $51.29 | $81.28 | $138.04 |
Martin's Point Setting Professional Modifier None Typical Low $47.86 Median $61.66 Typical High $70.79 | Professional | None | $47.86 | $61.66 | $70.79 |
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 $63.10 Median $81.28 Typical High $125.89 | Professional | None | $63.10 | $81.28 | $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 $23.99 Median $25.70 Typical High $35.48 | Professional | 52 · Reduced service | $23.99 | $25.70 | $35.48 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $9.55 Median $10.47 Typical High $14.13 | Professional | 53 · Discontinued | $9.55 | $10.47 | $14.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.24 Median $7.76 Typical High $10.72 | Professional | 55 · Aftercare only | $7.24 | $7.76 | $10.72 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $4.79 Median $5.13 Typical High $7.08 | Professional | 56 · Pre-op care only | $4.79 | $5.13 | $7.08 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $23.99 Median $25.70 Typical High $35.48 | Professional | 52 · Reduced service | $23.99 | $25.70 | $35.48 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $9.55 Median $10.47 Typical High $14.13 | Professional | 53 · Discontinued | $9.55 | $10.47 | $14.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.24 Median $7.76 Typical High $10.72 | Professional | 55 · Aftercare only | $7.24 | $7.76 | $10.72 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $4.79 Median $5.13 Typical High $7.08 | Professional | 56 · Pre-op care only | $4.79 | $5.13 | $7.08 |
Where Maine sits
The same service costs 3.1 times more in Wisconsin than in Florida. 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· 28th of 51
$79.43
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.