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 $56.23 Median $114.82 Typical High $162.18 | Professional | None | $56.23 | $114.82 | $162.18 |
Anthem BCBS Setting Professional Modifier None Typical Low $46.77 Median $120.23 Typical High $234.42 | Professional | None | $46.77 | $120.23 | $234.42 |
Cigna Setting Professional Modifier None Typical Low $56.23 Median $125.89 Typical High $213.80 | Professional | None | $56.23 | $125.89 | $213.80 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $46.77 Median $109.65 Typical High $251.19 | Professional | None | $46.77 | $109.65 | $251.19 |
Martin's Point Setting Professional Modifier None Typical Low $56.23 Median $114.82 Typical High $158.49 | Professional | None | $56.23 | $114.82 | $158.49 |
United Setting Professional Modifier None Typical Low $46.77 Median $107.15 Typical High $194.98 | Professional | None | $46.77 | $107.15 | $194.98 |
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 $28.18 Median $54.95 Typical High $79.43 | Professional | 52 · Reduced service | $28.18 | $54.95 | $79.43 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $21.88 Typical High $31.62 | Professional | 53 · Discontinued | $11.48 | $21.88 | $31.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $16.60 Typical High $23.99 | Professional | 55 · Aftercare only | $8.51 | $16.60 | $23.99 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.62 Median $10.96 Typical High $15.85 | Professional | 56 · Pre-op care only | $5.62 | $10.96 | $15.85 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $28.18 Median $54.95 Typical High $79.43 | Professional | 52 · Reduced service | $28.18 | $54.95 | $79.43 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $21.88 Typical High $31.62 | Professional | 53 · Discontinued | $11.48 | $21.88 | $31.62 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $16.60 Typical High $23.99 | Professional | 55 · Aftercare only | $8.51 | $16.60 | $23.99 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.62 Median $10.96 Typical High $15.85 | Professional | 56 · Pre-op care only | $5.62 | $10.96 | $15.85 |
Where Maine sits
The same service costs 3.5 times more in Wisconsin than in Washington, DC. 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· 26th of 51
$117
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.