How much rates vary
Facilitymedian $3,020 · 10th to 90th $2,344 to $7,244Professionalmedian $2,570 · 10th to 90th $2,455 to $2,692
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 $2,570.40 Median $2,630.27 Typical High $2,630.27 | Professional | None | $2,570.40 | $2,630.27 | $2,630.27 |
Anthem BCBS Setting Facility Modifier None Typical Low $2,344.23 Median $3,019.95 Typical High $5,011.87 | Facility | None | $2,344.23 | $3,019.95 | $5,011.87 |
Anthem BCBS Setting Professional Modifier None Typical Low $2,570.40 Median $2,570.40 Typical High $2,754.23 | Professional | None | $2,570.40 | $2,570.40 | $2,754.23 |
Cigna Setting Facility Modifier None Typical Low $2,754.23 Median $2,754.23 Typical High $7,244.36 | Facility | None | $2,754.23 | $2,754.23 | $7,244.36 |
Cigna Setting Professional Modifier None Typical Low $2,570.40 Median $2,570.40 Typical High $2,570.40 | Professional | None | $2,570.40 | $2,570.40 | $2,570.40 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $2,454.71 Median $2,570.40 Typical High $3,548.13 | Professional | None | $2,454.71 | $2,570.40 | $3,548.13 |
Martin's Point Setting Professional Modifier None Typical Low $2,570.40 Median $2,630.27 Typical High $2,630.27 | Professional | None | $2,570.40 | $2,630.27 | $2,630.27 |
United Setting Professional Modifier None Typical Low $2,454.71 Median $2,454.71 Typical High $3,630.78 | Professional | None | $2,454.71 | $2,454.71 | $3,630.78 |
10 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 $1,258.93 Median $1,318.26 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,258.93 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $512.86 Median $524.81 Typical High $524.81 | Professional | 53 · Discontinued | $512.86 | $524.81 | $524.81 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $1,905.46 Median $1,995.26 Typical High $1,995.26 | Professional | 54 · Surgery only | $1,905.46 | $1,995.26 | $1,995.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $380.19 Median $398.11 Typical High $398.11 | Professional | 55 · Aftercare only | $380.19 | $398.11 | $398.11 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $257.04 Median $263.03 Typical High $263.03 | Professional | 56 · Pre-op care only | $257.04 | $263.03 | $263.03 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $1,258.93 Median $1,318.26 Typical High $1,318.26 | Professional | 52 · Reduced service | $1,258.93 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $512.86 Median $524.81 Typical High $524.81 | Professional | 53 · Discontinued | $512.86 | $524.81 | $524.81 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $1,905.46 Median $1,995.26 Typical High $1,995.26 | Professional | 54 · Surgery only | $1,905.46 | $1,995.26 | $1,995.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $380.19 Median $398.11 Typical High $398.11 | Professional | 55 · Aftercare only | $380.19 | $398.11 | $398.11 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $257.04 Median $263.03 Typical High $263.03 | Professional | 56 · Pre-op care only | $257.04 | $263.03 | $263.03 |
Where Maine sits
Rates are fairly even across states for this service. 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· 17th of 51
$2,570
AK $3,020KS $2,570
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.