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 $245.47 Median $251.19 Typical High $616.60 | Professional | None | $245.47 | $251.19 | $616.60 |
Anthem BCBS Setting Professional Modifier None Typical Low $257.04 Median $346.74 Typical High $549.54 | Professional | None | $257.04 | $346.74 | $549.54 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $354.81 Typical High $602.56 | Professional | None | $281.84 | $354.81 | $602.56 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $239.88 Median $380.19 Typical High $602.56 | Professional | None | $239.88 | $380.19 | $602.56 |
Martin's Point Setting Professional Modifier None Typical Low $251.19 Median $251.19 Typical High $616.60 | Professional | None | $251.19 | $251.19 | $616.60 |
United Setting Professional Modifier None Typical Low $234.42 Median $331.13 Typical High $524.81 | Professional | None | $234.42 | $331.13 | $524.81 |
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 $117.49 Median $123.03 Typical High $138.04 | Professional | 52 · Reduced service | $117.49 | $123.03 | $138.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $46.77 Median $50.12 Typical High $54.95 | Professional | 53 · Discontinued | $46.77 | $50.12 | $54.95 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $37.15 Typical High $40.74 | Professional | 55 · Aftercare only | $35.48 | $37.15 | $40.74 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.44 Median $25.12 Typical High $27.54 | Professional | 56 · Pre-op care only | $23.44 | $25.12 | $27.54 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $123.03 Median $123.03 Typical High $138.04 | Professional | 52 · Reduced service | $123.03 | $123.03 | $138.04 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $50.12 Median $50.12 Typical High $54.95 | Professional | 53 · Discontinued | $50.12 | $50.12 | $54.95 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $37.15 Median $37.15 Typical High $40.74 | Professional | 55 · Aftercare only | $37.15 | $37.15 | $40.74 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $25.12 Median $25.12 Typical High $27.54 | Professional | 56 · Pre-op care only | $25.12 | $25.12 | $27.54 |
Where Maine sits
The same service costs 2.8 times more in Alaska than in New York. 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· 20th of 51
$347
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.