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 $331.13 Median $346.74 Typical High $346.74 | Professional | None | $331.13 | $346.74 | $346.74 |
Anthem BCBS Setting Facility Modifier None Typical Low $316.23 Median $398.11 Typical High $1,023.29 | Facility | None | $316.23 | $398.11 | $1,023.29 |
Anthem BCBS Setting Professional Modifier None Typical Low $331.13 Median $331.13 Typical High $354.81 | Professional | None | $331.13 | $331.13 | $354.81 |
Cigna Setting Facility Modifier None Typical Low $323.59 Median $436.52 Typical High $467.74 | Facility | None | $323.59 | $436.52 | $467.74 |
Cigna Setting Professional Modifier None Typical Low $331.13 Median $331.13 Typical High $331.13 | Professional | None | $331.13 | $331.13 | $331.13 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $323.59 Median $331.13 Typical High $467.74 | Professional | None | $323.59 | $331.13 | $467.74 |
Martin's Point Setting Professional Modifier None Typical Low $331.13 Median $346.74 Typical High $346.74 | Professional | None | $331.13 | $346.74 | $346.74 |
United Setting Professional Modifier None Typical Low $323.59 Median $323.59 Typical High $489.78 | Professional | None | $323.59 | $323.59 | $489.78 |
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 $165.96 Median $169.82 Typical High $169.82 | Professional | 52 · Reduced service | $165.96 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $66.07 Median $69.18 Typical High $69.18 | Professional | 53 · Discontinued | $66.07 | $69.18 | $69.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $48.98 Median $51.29 Typical High $51.29 | Professional | 55 · Aftercare only | $48.98 | $51.29 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $33.11 Median $34.67 Typical High $34.67 | Professional | 56 · Pre-op care only | $33.11 | $34.67 | $34.67 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $165.96 Median $169.82 Typical High $169.82 | Professional | 52 · Reduced service | $165.96 | $169.82 | $169.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $66.07 Median $69.18 Typical High $69.18 | Professional | 53 · Discontinued | $66.07 | $69.18 | $69.18 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $48.98 Median $51.29 Typical High $51.29 | Professional | 55 · Aftercare only | $48.98 | $51.29 | $51.29 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $33.11 Median $34.67 Typical High $34.67 | Professional | 56 · Pre-op care only | $33.11 | $34.67 | $34.67 |
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· 31st of 51
$331
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.