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 $21.88 Median $25.70 Typical High $26.30 | Professional | None | $21.88 | $25.70 | $26.30 |
Anthem BCBS Setting Professional Modifier None Typical Low $24.55 Median $36.31 Typical High $50.12 | Professional | None | $24.55 | $36.31 | $50.12 |
Cigna Setting Professional Modifier None Typical Low $23.99 Median $23.99 Typical High $23.99 | Professional | None | $23.99 | $23.99 | $23.99 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $23.99 Median $31.62 Typical High $40.74 | Professional | None | $23.99 | $31.62 | $40.74 |
Martin's Point Setting Professional Modifier None Typical Low $22.91 Median $25.70 Typical High $25.70 | Professional | None | $22.91 | $25.70 | $25.70 |
United Setting Professional Modifier None Typical Low $23.99 Median $33.88 Typical High $53.70 | Professional | None | $23.99 | $33.88 | $53.70 |
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 $10.96 Median $12.88 Typical High $13.18 | Professional | 52 · Reduced service | $10.96 | $12.88 | $13.18 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $4.47 Median $5.13 Typical High $5.25 | Professional | 53 · Discontinued | $4.47 | $5.13 | $5.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.31 Median $3.89 Typical High $3.98 | Professional | 55 · Aftercare only | $3.31 | $3.89 | $3.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.19 Median $2.57 Typical High $2.63 | Professional | 56 · Pre-op care only | $2.19 | $2.57 | $2.63 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $11.48 Median $12.88 Typical High $12.88 | Professional | 52 · Reduced service | $11.48 | $12.88 | $12.88 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $4.57 Median $5.13 Typical High $5.13 | Professional | 53 · Discontinued | $4.57 | $5.13 | $5.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.47 Median $3.89 Typical High $3.89 | Professional | 55 · Aftercare only | $3.47 | $3.89 | $3.89 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.29 Median $2.57 Typical High $2.57 | Professional | 56 · Pre-op care only | $2.29 | $2.57 | $2.57 |
Where Maine sits
The same service costs 4.1 times more in Wyoming than in Kentucky. 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· 20th of 51
$28.84
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.