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 $104.71 Median $109.65 Typical High $109.65 | Professional | None | $104.71 | $109.65 | $109.65 |
Anthem BCBS Setting Facility Modifier None Typical Low $117.49 Median $151.36 Typical High $251.19 | Facility | None | $117.49 | $151.36 | $251.19 |
Anthem BCBS Setting Professional Modifier None Typical Low $104.71 Median $104.71 Typical High $114.82 | Professional | None | $104.71 | $104.71 | $114.82 |
Cigna Setting Facility Modifier None Typical Low $87.10 Median $147.91 Typical High $190.55 | Facility | None | $87.10 | $147.91 | $190.55 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $104.71 Typical High $104.71 | Professional | None | $104.71 | $104.71 | $104.71 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $104.71 Median $120.23 Typical High $173.78 | Professional | None | $104.71 | $120.23 | $173.78 |
Martin's Point Setting Professional Modifier None Typical Low $104.71 Median $109.65 Typical High $109.65 | Professional | None | $104.71 | $109.65 | $109.65 |
United Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $208.93 | Professional | None | $120.23 | $120.23 | $208.93 |
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 $52.48 Median $54.95 Typical High $54.95 | Professional | 52 · Reduced service | $52.48 | $54.95 | $54.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $21.88 Typical High $21.88 | Professional | 53 · Discontinued | $20.89 | $21.88 | $21.88 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $16.22 Typical High $16.22 | Professional | 55 · Aftercare only | $15.85 | $16.22 | $16.22 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $10.96 Typical High $10.96 | Professional | 56 · Pre-op care only | $10.47 | $10.96 | $10.96 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $52.48 Median $54.95 Typical High $54.95 | Professional | 52 · Reduced service | $52.48 | $54.95 | $54.95 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $21.88 Typical High $21.88 | Professional | 53 · Discontinued | $20.89 | $21.88 | $21.88 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.85 Median $16.22 Typical High $16.22 | Professional | 55 · Aftercare only | $15.85 | $16.22 | $16.22 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.47 Median $10.96 Typical High $10.96 | Professional | 56 · Pre-op care only | $10.47 | $10.96 | $10.96 |
Where Maine sits
The same service costs 1.9 times more in Wyoming than in Vermont. 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· 47th of 51
$105
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.