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 $117.49 Median $128.82 Typical High $154.88 | Professional | None | $117.49 | $128.82 | $154.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $114.82 Median $134.90 Typical High $229.09 | Professional | None | $114.82 | $134.90 | $229.09 |
Cigna Setting Professional Modifier None Typical Low $131.83 Median $147.91 Typical High $269.15 | Professional | None | $131.83 | $147.91 | $269.15 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $123.03 Median $158.49 Typical High $223.87 | Professional | None | $123.03 | $158.49 | $223.87 |
Martin's Point Setting Professional Modifier None Typical Low $120.23 Median $128.82 Typical High $154.88 | Professional | None | $120.23 | $128.82 | $154.88 |
United Setting Professional Modifier None Typical Low $123.03 Median $173.78 Typical High $239.88 | Professional | None | $123.03 | $173.78 | $239.88 |
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 $58.88 Median $64.57 Typical High $64.57 | Professional | 52 · Reduced service | $58.88 | $64.57 | $64.57 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $23.44 Median $25.70 Typical High $25.70 | Professional | 53 · Discontinued | $23.44 | $25.70 | $25.70 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $17.38 Median $19.50 Typical High $19.50 | Professional | 55 · Aftercare only | $17.38 | $19.50 | $19.50 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $11.75 Median $12.88 Typical High $12.88 | Professional | 56 · Pre-op care only | $11.75 | $12.88 | $12.88 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $63.10 Median $64.57 Typical High $64.57 | Professional | 52 · Reduced service | $63.10 | $64.57 | $64.57 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $25.12 Median $25.70 Typical High $25.70 | Professional | 53 · Discontinued | $25.12 | $25.70 | $25.70 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $18.62 Median $19.50 Typical High $19.50 | Professional | 55 · Aftercare only | $18.62 | $19.50 | $19.50 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $12.59 Median $12.88 Typical High $12.88 | Professional | 56 · Pre-op care only | $12.59 | $12.88 | $12.88 |
Where Maine sits
The same service costs 3.2 times more in Alaska 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· 25th of 51
$145
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.