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 $87.10 Median $87.10 Typical High $112.20 | Professional | None | $87.10 | $87.10 | $112.20 |
Anthem BCBS Setting Professional Modifier None Typical Low $77.62 Median $93.33 Typical High $154.88 | Professional | None | $77.62 | $93.33 | $154.88 |
Cigna Setting Professional Modifier None Typical Low $95.50 Median $109.65 Typical High $173.78 | Professional | None | $95.50 | $109.65 | $173.78 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $85.11 Median $125.89 Typical High $162.18 | Professional | None | $85.11 | $125.89 | $162.18 |
Martin's Point Setting Professional Modifier None Typical Low $87.10 Median $87.10 Typical High $120.23 | Professional | None | $87.10 | $87.10 | $120.23 |
United Setting Professional Modifier None Typical Low $83.18 Median $131.83 Typical High $162.18 | Professional | None | $83.18 | $131.83 | $162.18 |
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 $42.66 Median $43.65 Typical High $44.67 | Professional | 52 · Reduced service | $42.66 | $43.65 | $44.67 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $16.98 Median $17.38 Typical High $17.78 | Professional | 53 · Discontinued | $16.98 | $17.38 | $17.78 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $13.18 Typical High $13.18 | Professional | 55 · Aftercare only | $12.88 | $13.18 | $13.18 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.51 Median $8.71 Typical High $8.91 | Professional | 56 · Pre-op care only | $8.51 | $8.71 | $8.91 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $43.65 Median $43.65 Typical High $43.65 | Professional | 52 · Reduced service | $43.65 | $43.65 | $43.65 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $17.38 Typical High $17.38 | Professional | 53 · Discontinued | $17.38 | $17.38 | $17.38 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $13.18 Median $13.18 Typical High $13.18 | Professional | 55 · Aftercare only | $13.18 | $13.18 | $13.18 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $8.71 Typical High $8.71 | Professional | 56 · Pre-op care only | $8.71 | $8.71 | $8.71 |
Where Maine sits
The same service costs 2.9 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· 27th of 51
$100
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.