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 $190.55 Median $199.53 Typical High $407.38 | Professional | None | $190.55 | $199.53 | $407.38 |
Anthem BCBS Setting Facility Modifier None Typical Low $181.97 Median $234.42 Typical High $389.05 | Facility | None | $181.97 | $234.42 | $389.05 |
Anthem BCBS Setting Professional Modifier None Typical Low $190.55 Median $190.55 Typical High $208.93 | Professional | None | $190.55 | $190.55 | $208.93 |
Cigna Setting Facility Modifier None Typical Low $186.21 Median $251.19 Typical High $269.15 | Facility | None | $186.21 | $251.19 | $269.15 |
Cigna Setting Professional Modifier None Typical Low $190.55 Median $190.55 Typical High $190.55 | Professional | None | $190.55 | $190.55 | $190.55 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $186.21 Median $190.55 Typical High $269.15 | Professional | None | $186.21 | $190.55 | $269.15 |
Martin's Point Setting Professional Modifier None Typical Low $190.55 Median $199.53 Typical High $407.38 | Professional | None | $190.55 | $199.53 | $407.38 |
United Setting Professional Modifier None Typical Low $186.21 Median $186.21 Typical High $281.84 | Professional | None | $186.21 | $186.21 | $281.84 |
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 $95.50 Median $100.00 Typical High $100.00 | Professional | 52 · Reduced service | $95.50 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $39.81 Typical High $39.81 | Professional | 53 · Discontinued | $38.02 | $39.81 | $39.81 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $29.51 Typical High $29.51 | Professional | 55 · Aftercare only | $28.84 | $29.51 | $29.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $19.95 Typical High $19.95 | Professional | 56 · Pre-op care only | $19.05 | $19.95 | $19.95 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $95.50 Median $100.00 Typical High $100.00 | Professional | 52 · Reduced service | $95.50 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $38.02 Median $39.81 Typical High $39.81 | Professional | 53 · Discontinued | $38.02 | $39.81 | $39.81 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $28.84 Median $29.51 Typical High $29.51 | Professional | 55 · Aftercare only | $28.84 | $29.51 | $29.51 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $19.05 Median $19.95 Typical High $19.95 | Professional | 56 · Pre-op care only | $19.05 | $19.95 | $19.95 |
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· 18th of 51
$191
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.