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 $309.03 Median $346.74 Typical High $407.38 | Professional | None | $309.03 | $346.74 | $407.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $363.08 Median $457.09 Typical High $741.31 | Professional | None | $363.08 | $457.09 | $741.31 |
Cigna Setting Professional Modifier None Typical Low $457.09 Median $457.09 Typical High $457.09 | Professional | None | $457.09 | $457.09 | $457.09 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $295.12 Median $489.78 Typical High $794.33 | Professional | None | $295.12 | $489.78 | $794.33 |
Martin's Point Setting Professional Modifier None Typical Low $309.03 Median $346.74 Typical High $407.38 | Professional | None | $309.03 | $346.74 | $407.38 |
United Setting Professional Modifier None Typical Low $295.12 Median $407.38 Typical High $645.65 | Professional | None | $295.12 | $407.38 | $645.65 |
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 $204.17 Median $204.17 Typical High $213.80 | Professional | 52 · Reduced service | $204.17 | $204.17 | $213.80 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $81.28 Typical High $87.10 | Professional | 53 · Discontinued | $81.28 | $81.28 | $87.10 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $61.66 Typical High $64.57 | Professional | 55 · Aftercare only | $61.66 | $61.66 | $64.57 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $40.74 Typical High $43.65 | Professional | 56 · Pre-op care only | $40.74 | $40.74 | $43.65 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $204.17 Median $204.17 Typical High $208.93 | Professional | 52 · Reduced service | $204.17 | $204.17 | $208.93 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $81.28 Median $81.28 Typical High $83.18 | Professional | 53 · Discontinued | $81.28 | $81.28 | $83.18 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $61.66 Median $61.66 Typical High $63.10 | Professional | 55 · Aftercare only | $61.66 | $61.66 | $63.10 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $40.74 Median $40.74 Typical High $41.69 | Professional | 56 · Pre-op care only | $40.74 | $40.74 | $41.69 |
Where Maine sits
The same service costs 2.1 times more in Wyoming than in Maryland. 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· 29th of 51
$407
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.