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 $213.80 Median $213.80 Typical High $213.80 | Facility | None | $213.80 | $213.80 | $213.80 |
Aetna Setting Professional Modifier None Typical Low $204.17 Median $213.80 Typical High $218.78 | Professional | None | $204.17 | $213.80 | $218.78 |
Anthem BCBS Setting Facility Modifier None Typical Low $194.98 Median $251.19 Typical High $630.96 | Facility | None | $194.98 | $251.19 | $630.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $223.87 | Professional | None | $204.17 | $204.17 | $223.87 |
Cigna Setting Facility Modifier None Typical Low $199.53 Median $275.42 Typical High $288.40 | Facility | None | $199.53 | $275.42 | $288.40 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $204.17 | Professional | None | $204.17 | $204.17 | $204.17 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $199.53 Median $204.17 Typical High $295.12 | Professional | None | $199.53 | $204.17 | $295.12 |
Martin's Point Setting Professional Modifier None Typical Low $204.17 Median $213.80 Typical High $218.78 | Professional | None | $204.17 | $213.80 | $218.78 |
United Setting Professional Modifier None Typical Low $199.53 Median $199.53 Typical High $302.00 | Professional | None | $199.53 | $199.53 | $302.00 |
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 $102.33 Median $107.15 Typical High $107.15 | Professional | 52 · Reduced service | $102.33 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $42.66 Typical High $42.66 | Professional | 53 · Discontinued | $40.74 | $42.66 | $42.66 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $32.36 Typical High $32.36 | Professional | 55 · Aftercare only | $30.90 | $32.36 | $32.36 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $21.38 Typical High $21.38 | Professional | 56 · Pre-op care only | $20.42 | $21.38 | $21.38 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $102.33 Median $107.15 Typical High $107.15 | Professional | 52 · Reduced service | $102.33 | $107.15 | $107.15 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $40.74 Median $42.66 Typical High $42.66 | Professional | 53 · Discontinued | $40.74 | $42.66 | $42.66 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $30.90 Median $32.36 Typical High $32.36 | Professional | 55 · Aftercare only | $30.90 | $32.36 | $32.36 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $20.42 Median $21.38 Typical High $21.38 | Professional | 56 · Pre-op care only | $20.42 | $21.38 | $21.38 |
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· 45th of 51
$204
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.