How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $30.20 Median $31.62 Typical High $31.62 | Professional | None | $30.20 | $31.62 | $31.62 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.03 Median $33.11 Typical High $41.69 | Facility | None | $0.03 | $33.11 | $41.69 |
Anthem BCBS Setting Professional Modifier None Typical Low $23.44 Median $31.62 Typical High $35.48 | Professional | None | $23.44 | $31.62 | $35.48 |
Cigna Setting Facility Modifier None Typical Low $31.62 Median $31.62 Typical High $89.13 | Facility | None | $31.62 | $31.62 | $89.13 |
Cigna Setting Professional Modifier None Typical Low $31.62 Median $31.62 Typical High $31.62 | Professional | None | $31.62 | $31.62 | $31.62 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $30.90 Median $32.36 Typical High $44.67 | Professional | None | $30.90 | $32.36 | $44.67 |
Martin's Point Setting Professional Modifier None Typical Low $31.62 Median $31.62 Typical High $31.62 | Professional | None | $31.62 | $31.62 | $31.62 |
United Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $45.71 | Professional | None | $30.90 | $30.90 | $45.71 |
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 $15.14 Median $15.85 Typical High $15.85 | Professional | 52 · Reduced service | $15.14 | $15.85 | $15.85 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.03 Median $6.31 Typical High $6.31 | Professional | 53 · Discontinued | $6.03 | $6.31 | $6.31 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.57 Median $4.68 Typical High $4.68 | Professional | 55 · Aftercare only | $4.57 | $4.68 | $4.68 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.02 Median $3.16 Typical High $3.16 | Professional | 56 · Pre-op care only | $3.02 | $3.16 | $3.16 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $15.85 Median $15.85 Typical High $15.85 | Professional | 52 · Reduced service | $15.85 | $15.85 | $15.85 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $6.31 Median $6.31 Typical High $6.31 | Professional | 53 · Discontinued | $6.31 | $6.31 | $6.31 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $4.68 Median $4.68 Typical High $4.68 | Professional | 55 · Aftercare only | $4.68 | $4.68 | $4.68 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.16 Median $3.16 Typical High $3.16 | Professional | 56 · Pre-op care only | $3.16 | $3.16 | $3.16 |
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· 28th of 51
$31.62
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.