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 $58.88 Median $58.88 Typical High $58.88 | Facility | None | $58.88 | $58.88 | $58.88 |
Aetna Setting Professional Modifier None Typical Low $57.54 Median $58.88 Typical High $66.07 | Professional | None | $57.54 | $58.88 | $66.07 |
Anthem BCBS Setting Facility Modifier None Typical Low $53.70 Median $67.61 Typical High $173.78 | Facility | None | $53.70 | $67.61 | $173.78 |
Anthem BCBS Setting Professional Modifier None Typical Low $57.54 Median $57.54 Typical High $61.66 | Professional | None | $57.54 | $57.54 | $61.66 |
Cigna Setting Facility Modifier None Typical Low $54.95 Median $72.44 Typical High $81.28 | Facility | None | $54.95 | $72.44 | $81.28 |
Cigna Setting Professional Modifier None Typical Low $57.54 Median $57.54 Typical High $57.54 | Professional | None | $57.54 | $57.54 | $57.54 |
Community Health Options Setting Professional Modifier None Typical Low $83.18 Median $83.18 Typical High $83.18 | Professional | None | $83.18 | $83.18 | $83.18 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $54.95 Median $57.54 Typical High $79.43 | Professional | None | $54.95 | $57.54 | $79.43 |
Martin's Point Setting Facility Modifier None Typical Low $58.88 Median $58.88 Typical High $74.13 | Facility | None | $58.88 | $58.88 | $74.13 |
Martin's Point Setting Professional Modifier None Typical Low $57.54 Median $58.88 Typical High $66.07 | Professional | None | $57.54 | $58.88 | $66.07 |
United Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $83.18 | Professional | None | $54.95 | $54.95 | $83.18 |
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 $28.84 Median $29.51 Typical High $29.51 | Professional | 52 · Reduced service | $28.84 | $29.51 | $29.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $11.75 Typical High $11.75 | Professional | 53 · Discontinued | $11.48 | $11.75 | $11.75 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $8.91 Typical High $8.91 | Professional | 55 · Aftercare only | $8.51 | $8.91 | $8.91 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $5.89 Typical High $5.89 | Professional | 56 · Pre-op care only | $5.75 | $5.89 | $5.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $28.84 Median $29.51 Typical High $29.51 | Professional | 52 · Reduced service | $28.84 | $29.51 | $29.51 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $11.48 Median $11.75 Typical High $11.75 | Professional | 53 · Discontinued | $11.48 | $11.75 | $11.75 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $8.91 Typical High $8.91 | Professional | 55 · Aftercare only | $8.51 | $8.91 | $8.91 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.75 Median $5.89 Typical High $5.89 | Professional | 56 · Pre-op care only | $5.75 | $5.89 | $5.89 |
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· 48th of 51
$57.54
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.