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 Facility Modifier None Typical Low $22.91 Median $22.91 Typical High $354.81 | Facility | None | $22.91 | $22.91 | $354.81 |
Aetna Setting Professional Modifier None Typical Low $22.91 Median $158.49 Typical High $588.84 | Professional | None | $22.91 | $158.49 | $588.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $18.20 Median $39.81 Typical High $537.03 | Professional | None | $18.20 | $39.81 | $537.03 |
Cigna Setting Professional Modifier None Typical Low $26.30 Median $58.88 Typical High $758.58 | Professional | None | $26.30 | $58.88 | $758.58 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $19.50 Median $60.26 Typical High $524.81 | Professional | None | $19.50 | $60.26 | $524.81 |
Martin's Point Setting Professional Modifier None Typical Low $22.91 Median $158.49 Typical High $588.84 | Professional | None | $22.91 | $158.49 | $588.84 |
United Setting Professional Modifier None Typical Low $19.05 Median $60.26 Typical High $316.23 | Professional | None | $19.05 | $60.26 | $316.23 |
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 $11.48 Median $79.43 Typical High $177.83 | Professional | 52 · Reduced service | $11.48 | $79.43 | $177.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.68 Median $31.62 Typical High $70.79 | Professional | 53 · Discontinued | $4.68 | $31.62 | $70.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.47 Median $23.99 Typical High $52.48 | Professional | 55 · Aftercare only | $3.47 | $23.99 | $52.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.29 Median $15.85 Typical High $35.48 | Professional | 56 · Pre-op care only | $2.29 | $15.85 | $35.48 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $11.48 Median $11.48 Typical High $177.83 | Professional | 52 · Reduced service | $11.48 | $11.48 | $177.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $4.68 Median $4.68 Typical High $70.79 | Professional | 53 · Discontinued | $4.68 | $4.68 | $70.79 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.47 Median $3.47 Typical High $52.48 | Professional | 55 · Aftercare only | $3.47 | $3.47 | $52.48 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.29 Median $2.29 Typical High $35.48 | Professional | 56 · Pre-op care only | $2.29 | $2.29 | $35.48 |
Where Maine sits
The same service costs 17.4 times more in Hawaii 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· 39th of 51
$60.26
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.