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 $8.51 Median $8.51 Typical High $10.00 | Professional | None | $8.51 | $8.51 | $10.00 |
Anthem BCBS Setting Facility Modifier None Typical Low $19.95 Median $25.70 Typical High $42.66 | Facility | None | $19.95 | $25.70 | $42.66 |
Anthem BCBS Setting Professional Modifier None Typical Low $9.33 Median $10.96 Typical High $13.80 | Professional | None | $9.33 | $10.96 | $13.80 |
Cigna Setting Facility Modifier None Typical Low $10.96 Median $23.44 Typical High $28.18 | Facility | None | $10.96 | $23.44 | $28.18 |
Cigna Setting Professional Modifier None Typical Low $9.77 Median $9.77 Typical High $9.77 | Professional | None | $9.77 | $9.77 | $9.77 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $6.76 Median $19.95 Typical High $20.89 | Professional | None | $6.76 | $19.95 | $20.89 |
Martin's Point Setting Professional Modifier None Typical Low $8.51 Median $8.51 Typical High $8.91 | Professional | None | $8.51 | $8.51 | $8.91 |
United Setting Professional Modifier None Typical Low $4.90 Median $7.41 Typical High $17.38 | Professional | None | $4.90 | $7.41 | $17.38 |
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 $4.27 Median $4.27 Typical High $5.01 | Professional | 52 · Reduced service | $4.27 | $4.27 | $5.01 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1.70 Median $1.70 Typical High $2.00 | Professional | 53 · Discontinued | $1.70 | $1.70 | $2.00 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $1.26 Median $1.26 Typical High $1.48 | Professional | 55 · Aftercare only | $1.26 | $1.26 | $1.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.85 Median $0.85 Typical High $1.00 | Professional | 56 · Pre-op care only | $0.85 | $0.85 | $1.00 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $4.27 Median $4.27 Typical High $4.47 | Professional | 52 · Reduced service | $4.27 | $4.27 | $4.47 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $1.70 Median $1.70 Typical High $1.78 | Professional | 53 · Discontinued | $1.70 | $1.70 | $1.78 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $1.26 Median $1.26 Typical High $1.35 | Professional | 55 · Aftercare only | $1.26 | $1.26 | $1.35 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.85 Median $0.85 Typical High $0.89 | Professional | 56 · Pre-op care only | $0.85 | $0.85 | $0.89 |
Where Maine sits
The same service costs 46.8 times more in New York than in Arkansas. 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
$9.77
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.