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 Facility Modifier None Typical Low $288.40 Median $288.40 Typical High $288.40 | Facility | None | $288.40 | $288.40 | $288.40 |
Aetna Setting Professional Modifier None Typical Low $281.84 Median $288.40 Typical High $295.12 | Professional | None | $281.84 | $288.40 | $295.12 |
Anthem BCBS Setting Facility Modifier None Typical Low $263.03 Median $331.13 Typical High $549.54 | Facility | None | $263.03 | $331.13 | $549.54 |
Anthem BCBS Setting Professional Modifier None Typical Low $281.84 Median $281.84 Typical High $302.00 | Professional | None | $281.84 | $281.84 | $302.00 |
Cigna Setting Facility Modifier None Typical Low $269.15 Median $354.81 Typical High $398.11 | Facility | None | $269.15 | $354.81 | $398.11 |
Cigna Setting Professional Modifier None Typical Low $281.84 Median $281.84 Typical High $281.84 | Professional | None | $281.84 | $281.84 | $281.84 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $269.15 Median $281.84 Typical High $389.05 | Professional | None | $269.15 | $281.84 | $389.05 |
Martin's Point Setting Professional Modifier None Typical Low $281.84 Median $288.40 Typical High $295.12 | Professional | None | $281.84 | $288.40 | $295.12 |
United Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $407.38 | Professional | None | $269.15 | $269.15 | $407.38 |
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 $138.04 Median $144.54 Typical High $144.54 | Professional | 52 · Reduced service | $138.04 | $144.54 | $144.54 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $57.54 Typical High $57.54 | Professional | 53 · Discontinued | $56.23 | $57.54 | $57.54 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $43.65 Typical High $43.65 | Professional | 55 · Aftercare only | $41.69 | $43.65 | $43.65 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $28.84 Typical High $28.84 | Professional | 56 · Pre-op care only | $28.18 | $28.84 | $28.84 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $138.04 Median $144.54 Typical High $144.54 | Professional | 52 · Reduced service | $138.04 | $144.54 | $144.54 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $56.23 Median $57.54 Typical High $57.54 | Professional | 53 · Discontinued | $56.23 | $57.54 | $57.54 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $41.69 Median $43.65 Typical High $43.65 | Professional | 55 · Aftercare only | $41.69 | $43.65 | $43.65 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $28.18 Median $28.84 Typical High $28.84 | Professional | 56 · Pre-op care only | $28.18 | $28.84 | $28.84 |
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· 29th of 51
$282
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.