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 $75.86 Median $79.43 Typical High $81.28 | Professional | None | $75.86 | $79.43 | $81.28 |
Anthem BCBS Setting Facility Modifier None Typical Low $72.44 Median $93.33 Typical High $154.88 | Facility | None | $72.44 | $93.33 | $154.88 |
Anthem BCBS Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $83.18 | Professional | None | $75.86 | $75.86 | $83.18 |
Cigna Setting Facility Modifier None Typical Low $75.86 Median $102.33 Typical High $107.15 | Facility | None | $75.86 | $102.33 | $107.15 |
Cigna Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $75.86 | Professional | None | $75.86 | $75.86 | $75.86 |
Community Health Options Setting Facility Modifier None Typical Low $89.13 Median $89.13 Typical High $89.13 | Facility | None | $89.13 | $89.13 | $89.13 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $109.65 | Professional | None | $75.86 | $75.86 | $109.65 |
Martin's Point Setting Professional Modifier None Typical Low $75.86 Median $79.43 Typical High $81.28 | Professional | None | $75.86 | $79.43 | $81.28 |
United Setting Professional Modifier None Typical Low $75.86 Median $75.86 Typical High $112.20 | Professional | None | $75.86 | $75.86 | $112.20 |
10 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 $38.02 Median $39.81 Typical High $39.81 | Professional | 52 · Reduced service | $38.02 | $39.81 | $39.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $15.14 Median $15.85 Typical High $15.85 | Professional | 53 · Discontinued | $15.14 | $15.85 | $15.85 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $60.26 Typical High $60.26 | Professional | 54 · Surgery only | $57.54 | $60.26 | $60.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $12.02 Typical High $12.02 | Professional | 55 · Aftercare only | $11.48 | $12.02 | $12.02 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $7.94 Typical High $7.94 | Professional | 56 · Pre-op care only | $7.59 | $7.94 | $7.94 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $38.02 Median $39.81 Typical High $39.81 | Professional | 52 · Reduced service | $38.02 | $39.81 | $39.81 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $15.14 Median $15.85 Typical High $15.85 | Professional | 53 · Discontinued | $15.14 | $15.85 | $15.85 |
Martin's Point Setting Professional Modifier 54 · Surgery only Typical Low $57.54 Median $60.26 Typical High $60.26 | Professional | 54 · Surgery only | $57.54 | $60.26 | $60.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $11.48 Median $12.02 Typical High $12.02 | Professional | 55 · Aftercare only | $11.48 | $12.02 | $12.02 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $7.59 Median $7.94 Typical High $7.94 | Professional | 56 · Pre-op care only | $7.59 | $7.94 | $7.94 |
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· 32nd of 51
$75.86
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.