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 $100.00 Median $125.89 Typical High $125.89 | Professional | None | $100.00 | $125.89 | $125.89 |
Anthem BCBS Setting Professional Modifier None Typical Low $85.11 Median $114.82 Typical High $154.88 | Professional | None | $85.11 | $114.82 | $154.88 |
Cigna Setting Professional Modifier None Typical Low $81.28 Median $81.28 Typical High $81.28 | Professional | None | $81.28 | $81.28 | $81.28 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $102.33 Median $117.49 Typical High $162.18 | Professional | None | $102.33 | $117.49 | $162.18 |
Martin's Point Setting Professional Modifier None Typical Low $102.33 Median $125.89 Typical High $125.89 | Professional | None | $102.33 | $125.89 | $125.89 |
United Setting Professional Modifier None Typical Low $93.33 Median $134.90 Typical High $223.87 | Professional | None | $93.33 | $134.90 | $223.87 |
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 $50.12 Median $63.10 Typical High $63.10 | Professional | 52 · Reduced service | $50.12 | $63.10 | $63.10 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $19.95 Median $25.12 Typical High $25.12 | Professional | 53 · Discontinued | $19.95 | $25.12 | $25.12 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $15.14 Median $18.62 Typical High $18.62 | Professional | 55 · Aftercare only | $15.14 | $18.62 | $18.62 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.00 Median $12.59 Typical High $12.59 | Professional | 56 · Pre-op care only | $10.00 | $12.59 | $12.59 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $51.29 Median $63.10 Typical High $63.10 | Professional | 52 · Reduced service | $51.29 | $63.10 | $63.10 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $20.89 Median $25.12 Typical High $25.12 | Professional | 53 · Discontinued | $20.89 | $25.12 | $25.12 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $15.49 Median $18.62 Typical High $18.62 | Professional | 55 · Aftercare only | $15.49 | $18.62 | $18.62 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $10.23 Median $12.59 Typical High $12.59 | Professional | 56 · Pre-op care only | $10.23 | $12.59 | $12.59 |
Where Maine sits
The same service costs 3.3 times more in Alaska than in Wyoming. 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· 19th of 51
$115
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.