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 $173.78 Median $177.83 Typical High $363.08 | Professional | None | $173.78 | $177.83 | $363.08 |
Anthem BCBS Setting Facility Modifier None Typical Low $158.49 Median $204.17 Typical High $338.84 | Facility | None | $158.49 | $204.17 | $338.84 |
Anthem BCBS Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $186.21 | Professional | None | $173.78 | $173.78 | $186.21 |
Cigna Setting Facility Modifier None Typical Low $162.18 Median $213.80 Typical High $245.47 | Facility | None | $162.18 | $213.80 | $245.47 |
Cigna Setting Professional Modifier None Typical Low $173.78 Median $173.78 Typical High $173.78 | Professional | None | $173.78 | $173.78 | $173.78 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $162.18 Median $173.78 Typical High $239.88 | Professional | None | $162.18 | $173.78 | $239.88 |
Martin's Point Setting Professional Modifier None Typical Low $173.78 Median $177.83 Typical High $363.08 | Professional | None | $173.78 | $177.83 | $363.08 |
United Setting Professional Modifier None Typical Low $162.18 Median $162.18 Typical High $245.47 | Professional | None | $162.18 | $162.18 | $245.47 |
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 $87.10 Median $89.13 Typical High $89.13 | Professional | 52 · Reduced service | $87.10 | $89.13 | $89.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $36.31 Typical High $36.31 | Professional | 53 · Discontinued | $34.67 | $36.31 | $36.31 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $134.90 Typical High $134.90 | Professional | 54 · Surgery only | $128.82 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $26.92 Typical High $26.92 | Professional | 55 · Aftercare only | $25.70 | $26.92 | $26.92 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $17.78 Typical High $17.78 | Professional | 56 · Pre-op care only | $17.38 | $17.78 | $17.78 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $87.10 Median $89.13 Typical High $89.13 | Professional | 52 · Reduced service | $87.10 | $89.13 | $89.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $36.31 Typical High $36.31 | Professional | 53 · Discontinued | $34.67 | $36.31 | $36.31 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $128.82 Median $134.90 Typical High $134.90 | Professional | 54 · Surgery only | $128.82 | $134.90 | $134.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $25.70 Median $26.92 Typical High $26.92 | Professional | 55 · Aftercare only | $25.70 | $26.92 | $26.92 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $17.78 Typical High $17.78 | Professional | 56 · Pre-op care only | $17.38 | $17.78 | $17.78 |
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· 15th of 51
$174
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.