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 Facility Modifier None Typical Low $165.96 Median $165.96 Typical High $165.96 | Facility | None | $165.96 | $165.96 | $165.96 |
Aetna Setting Professional Modifier None Typical Low $162.18 Median $165.96 Typical High $338.84 | Professional | None | $162.18 | $165.96 | $338.84 |
Anthem BCBS Setting Facility Modifier None Typical Low $169.82 Median $218.78 Typical High $363.08 | Facility | None | $169.82 | $218.78 | $363.08 |
Anthem BCBS Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $177.83 | Professional | None | $162.18 | $162.18 | $177.83 |
Cigna Setting Facility Modifier None Typical Low $169.82 Median $223.87 Typical High $257.04 | Facility | None | $169.82 | $223.87 | $257.04 |
Cigna Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $162.18 | Professional | None | $162.18 | $162.18 | $162.18 |
Community Health Options Setting Professional Modifier None Typical Low $263.03 Median $263.03 Typical High $263.03 | Professional | None | $263.03 | $263.03 | $263.03 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $162.18 Median $177.83 Typical High $257.04 | Professional | None | $162.18 | $177.83 | $257.04 |
Martin's Point Setting Facility Modifier None Typical Low $165.96 Median $165.96 Typical High $213.80 | Facility | None | $165.96 | $165.96 | $213.80 |
Martin's Point Setting Professional Modifier None Typical Low $162.18 Median $165.96 Typical High $338.84 | Professional | None | $162.18 | $165.96 | $338.84 |
United Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $263.03 | Professional | None | $177.83 | $177.83 | $263.03 |
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 $79.43 Median $83.18 Typical High $83.18 | Professional | 52 · Reduced service | $79.43 | $83.18 | $83.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $33.11 Typical High $33.11 | Professional | 53 · Discontinued | $32.36 | $33.11 | $33.11 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $25.12 Typical High $25.12 | Professional | 55 · Aftercare only | $23.99 | $25.12 | $25.12 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.85 Median $16.60 Typical High $16.60 | Professional | 56 · Pre-op care only | $15.85 | $16.60 | $16.60 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $79.43 Median $83.18 Typical High $83.18 | Professional | 52 · Reduced service | $79.43 | $83.18 | $83.18 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $32.36 Median $33.11 Typical High $33.11 | Professional | 53 · Discontinued | $32.36 | $33.11 | $33.11 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $23.99 Median $25.12 Typical High $25.12 | Professional | 55 · Aftercare only | $23.99 | $25.12 | $25.12 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $15.85 Median $16.60 Typical High $16.60 | Professional | 56 · Pre-op care only | $15.85 | $16.60 | $16.60 |
Where Maine sits
The same service costs 1.9 times more in Wyoming than in Nevada. 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
$166
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.