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 $467.74 Median $489.78 Typical High $489.78 | Professional | None | $467.74 | $489.78 | $489.78 |
Anthem BCBS Setting Facility Modifier None Typical Low $288.40 Median $371.54 Typical High $645.65 | Facility | None | $288.40 | $371.54 | $645.65 |
Anthem BCBS Setting Professional Modifier None Typical Low $426.58 Median $501.19 Typical High $575.44 | Professional | None | $426.58 | $501.19 | $575.44 |
Cigna Setting Facility Modifier None Typical Low $302.00 Median $724.44 Typical High $741.31 | Facility | None | $302.00 | $724.44 | $741.31 |
Cigna Setting Professional Modifier None Typical Low $512.86 Median $512.86 Typical High $512.86 | Professional | None | $512.86 | $512.86 | $512.86 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $512.86 Median $575.44 Typical High $831.76 | Professional | None | $512.86 | $575.44 | $831.76 |
Martin's Point Setting Professional Modifier None Typical Low $478.63 Median $489.78 Typical High $489.78 | Professional | None | $478.63 | $489.78 | $489.78 |
United Setting Professional Modifier None Typical Low $575.44 Median $575.44 Typical High $870.96 | Professional | None | $575.44 | $575.44 | $870.96 |
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 $234.42 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $234.42 | $245.47 | $245.47 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $93.33 Median $97.72 Typical High $97.72 | Professional | 53 · Discontinued | $93.33 | $97.72 | $97.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $70.79 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $48.98 Typical High $48.98 | Professional | 56 · Pre-op care only | $46.77 | $48.98 | $48.98 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $239.88 Median $245.47 Typical High $245.47 | Professional | 52 · Reduced service | $239.88 | $245.47 | $245.47 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $95.50 Median $97.72 Typical High $97.72 | Professional | 53 · Discontinued | $95.50 | $97.72 | $97.72 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $72.44 Median $74.13 Typical High $74.13 | Professional | 55 · Aftercare only | $72.44 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $47.86 Median $48.98 Typical High $48.98 | Professional | 56 · Pre-op care only | $47.86 | $48.98 | $48.98 |
Where Maine sits
The same service costs 1.6 times more in Alaska than in Idaho. 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· 29th of 51
$513
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.