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 $15.49 Median $16.60 Typical High $16.60 | Professional | None | $15.49 | $16.60 | $16.60 |
Anthem BCBS Setting Professional Modifier None Typical Low $15.49 Median $19.95 Typical High $32.36 | Professional | None | $15.49 | $19.95 | $32.36 |
Cigna Setting Professional Modifier None Typical Low $17.78 Median $20.89 Typical High $37.15 | Professional | None | $17.78 | $20.89 | $37.15 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $15.85 Median $21.88 Typical High $33.88 | Professional | None | $15.85 | $21.88 | $33.88 |
Martin's Point Setting Professional Modifier None Typical Low $16.22 Median $16.60 Typical High $16.60 | Professional | None | $16.22 | $16.60 | $16.60 |
United Setting Professional Modifier None Typical Low $15.49 Median $21.88 Typical High $33.88 | Professional | None | $15.49 | $21.88 | $33.88 |
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 $7.76 Median $8.32 Typical High $8.32 | Professional | 52 · Reduced service | $7.76 | $8.32 | $8.32 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.09 Median $3.31 Typical High $3.31 | Professional | 53 · Discontinued | $3.09 | $3.31 | $3.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.34 Median $2.45 Typical High $2.45 | Professional | 55 · Aftercare only | $2.34 | $2.45 | $2.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.55 Median $1.66 Typical High $1.66 | Professional | 56 · Pre-op care only | $1.55 | $1.66 | $1.66 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $8.13 Median $8.32 Typical High $8.32 | Professional | 52 · Reduced service | $8.13 | $8.32 | $8.32 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $3.24 Median $3.31 Typical High $3.31 | Professional | 53 · Discontinued | $3.24 | $3.31 | $3.31 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.40 Median $2.45 Typical High $2.45 | Professional | 55 · Aftercare only | $2.40 | $2.45 | $2.45 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.62 Median $1.66 Typical High $1.66 | Professional | 56 · Pre-op care only | $1.62 | $1.66 | $1.66 |
Where Maine sits
The same service costs 3.2 times more in Alaska 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· 19th of 51
$20.89
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.