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 $302.00 Median $316.23 Typical High $316.23 | Professional | None | $302.00 | $316.23 | $316.23 |
Anthem BCBS Setting Facility Modifier None Typical Low $0.03 Median $331.13 Typical High $407.38 | Facility | None | $0.03 | $331.13 | $407.38 |
Anthem BCBS Setting Professional Modifier None Typical Low $239.88 Median $323.59 Typical High $371.54 | Professional | None | $239.88 | $323.59 | $371.54 |
Cigna Setting Facility Modifier None Typical Low $323.59 Median $323.59 Typical High $933.25 | Facility | None | $323.59 | $323.59 | $933.25 |
Cigna Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $323.59 | Professional | None | $323.59 | $323.59 | $323.59 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $309.03 Median $323.59 Typical High $446.68 | Professional | None | $309.03 | $323.59 | $446.68 |
Martin's Point Setting Professional Modifier None Typical Low $309.03 Median $316.23 Typical High $316.23 | Professional | None | $309.03 | $316.23 | $316.23 |
United Setting Professional Modifier None Typical Low $309.03 Median $309.03 Typical High $467.74 | Professional | None | $309.03 | $309.03 | $467.74 |
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 $151.36 Median $158.49 Typical High $158.49 | Professional | 52 · Reduced service | $151.36 | $158.49 | $158.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $60.26 Median $63.10 Typical High $63.10 | Professional | 53 · Discontinued | $60.26 | $63.10 | $63.10 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $45.71 Median $47.86 Typical High $47.86 | Professional | 55 · Aftercare only | $45.71 | $47.86 | $47.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $30.20 Median $31.62 Typical High $31.62 | Professional | 56 · Pre-op care only | $30.20 | $31.62 | $31.62 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $154.88 Median $158.49 Typical High $158.49 | Professional | 52 · Reduced service | $154.88 | $158.49 | $158.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $61.66 Median $63.10 Typical High $63.10 | Professional | 53 · Discontinued | $61.66 | $63.10 | $63.10 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $46.77 Median $47.86 Typical High $47.86 | Professional | 55 · Aftercare only | $46.77 | $47.86 | $47.86 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $30.90 Median $31.62 Typical High $31.62 | Professional | 56 · Pre-op care only | $30.90 | $31.62 | $31.62 |
Where Maine sits
The same service costs 2.3 times more in Alaska than in Montana. 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· 24th of 51
$324
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.