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 $17.78 Median $17.78 Typical High $17.78 | Facility | None | $17.78 | $17.78 | $17.78 |
Aetna Setting Professional Modifier None Typical Low $17.38 Median $17.78 Typical High $19.05 | Professional | None | $17.38 | $17.78 | $19.05 |
Anthem BCBS Setting Facility Modifier None Typical Low $16.60 Median $20.89 Typical High $34.67 | Facility | None | $16.60 | $20.89 | $34.67 |
Anthem BCBS Setting Professional Modifier None Typical Low $17.38 Median $17.38 Typical High $17.78 | Professional | None | $17.38 | $17.38 | $17.78 |
Cigna Setting Facility Modifier None Typical Low $16.98 Median $22.91 Typical High $23.99 | Facility | None | $16.98 | $22.91 | $23.99 |
Cigna Setting Professional Modifier None Typical Low $17.38 Median $17.38 Typical High $17.38 | Professional | None | $17.38 | $17.38 | $17.38 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $16.98 Median $17.38 Typical High $24.55 | Professional | None | $16.98 | $17.38 | $24.55 |
Martin's Point Setting Professional Modifier None Typical Low $17.38 Median $17.78 Typical High $19.05 | Professional | None | $17.38 | $17.78 | $19.05 |
United Setting Professional Modifier None Typical Low $16.98 Median $16.98 Typical High $25.70 | Professional | None | $16.98 | $16.98 | $25.70 |
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 $8.51 Median $8.91 Typical High $8.91 | Professional | 52 · Reduced service | $8.51 | $8.91 | $8.91 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $3.47 Median $3.55 Typical High $3.55 | Professional | 53 · Discontinued | $3.47 | $3.55 | $3.55 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $2.57 Median $2.69 Typical High $2.69 | Professional | 55 · Aftercare only | $2.57 | $2.69 | $2.69 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $1.74 Median $1.78 Typical High $1.78 | Professional | 56 · Pre-op care only | $1.74 | $1.78 | $1.78 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $8.51 Median $8.91 Typical High $8.91 | Professional | 52 · Reduced service | $8.51 | $8.91 | $8.91 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $3.47 Median $3.55 Typical High $3.55 | Professional | 53 · Discontinued | $3.47 | $3.55 | $3.55 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $2.57 Median $2.69 Typical High $2.69 | Professional | 55 · Aftercare only | $2.57 | $2.69 | $2.69 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $1.74 Median $1.78 Typical High $1.78 | Professional | 56 · Pre-op care only | $1.74 | $1.78 | $1.78 |
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· 17th of 51
$17.38
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.