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 $3.02 Median $3.02 Typical High $3.02 | Facility | None | $3.02 | $3.02 | $3.02 |
Aetna Setting Professional Modifier None Typical Low $2.88 Median $3.02 Typical High $6.17 | Professional | None | $2.88 | $3.02 | $6.17 |
Anthem BCBS Setting Facility Modifier None Typical Low $8.91 Median $8.91 Typical High $8.91 | Facility | None | $8.91 | $8.91 | $8.91 |
Anthem BCBS Setting Professional Modifier None Typical Low $2.88 Median $2.88 Typical High $3.16 | Professional | None | $2.88 | $2.88 | $3.16 |
Cigna Setting Facility Modifier None Typical Low $4.07 Median $4.07 Typical High $8.32 | Facility | None | $4.07 | $4.07 | $8.32 |
Cigna Setting Professional Modifier None Typical Low $2.88 Median $2.88 Typical High $2.88 | Professional | None | $2.88 | $2.88 | $2.88 |
Community Health Options Setting Facility Modifier None Typical Low $12.02 Median $12.02 Typical High $12.02 | Facility | None | $12.02 | $12.02 | $12.02 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2.88 Median $3.24 Typical High $4.68 | Professional | None | $2.88 | $3.24 | $4.68 |
Martin's Point Setting Professional Modifier None Typical Low $2.88 Median $3.02 Typical High $6.17 | Professional | None | $2.88 | $3.02 | $6.17 |
United Setting Professional Modifier None Typical Low $3.24 Median $3.24 Typical High $5.62 | Professional | None | $3.24 | $3.24 | $5.62 |
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 $1.45 Median $1.51 Typical High $1.51 | Professional | 52 · Reduced service | $1.45 | $1.51 | $1.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.58 Median $0.60 Typical High $0.60 | Professional | 53 · Discontinued | $0.58 | $0.60 | $0.60 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $0.43 Median $0.45 Typical High $0.45 | Professional | 55 · Aftercare only | $0.43 | $0.45 | $0.45 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.28 Median $0.30 Typical High $0.30 | Professional | 56 · Pre-op care only | $0.28 | $0.30 | $0.30 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1.45 Median $1.51 Typical High $1.51 | Professional | 52 · Reduced service | $1.45 | $1.51 | $1.51 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.58 Median $0.60 Typical High $0.60 | Professional | 53 · Discontinued | $0.58 | $0.60 | $0.60 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.43 Median $0.45 Typical High $0.45 | Professional | 55 · Aftercare only | $0.43 | $0.45 | $0.45 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.28 Median $0.30 Typical High $0.30 | Professional | 56 · Pre-op care only | $0.28 | $0.30 | $0.30 |
Where Maine sits
The same service costs 3.1 times more in Wyoming than in Delaware. 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· 35th of 51
$2.88
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.