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 $144.54 Median $147.91 Typical High $151.36 | Professional | None | $144.54 | $147.91 | $151.36 |
Anthem BCBS Setting Facility Modifier None Typical Low $131.83 Median $169.82 Typical High $436.52 | Facility | None | $131.83 | $169.82 | $436.52 |
Anthem BCBS Setting Professional Modifier None Typical Low $144.54 Median $144.54 Typical High $154.88 | Professional | None | $144.54 | $144.54 | $154.88 |
Cigna Setting Facility Modifier None Typical Low $138.04 Median $186.21 Typical High $204.17 | Facility | None | $138.04 | $186.21 | $204.17 |
Cigna Setting Professional Modifier None Typical Low $144.54 Median $144.54 Typical High $144.54 | Professional | None | $144.54 | $144.54 | $144.54 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $138.04 Median $144.54 Typical High $199.53 | Professional | None | $138.04 | $144.54 | $199.53 |
Martin's Point Setting Professional Modifier None Typical Low $144.54 Median $147.91 Typical High $151.36 | Professional | None | $144.54 | $147.91 | $151.36 |
United Setting Professional Modifier None Typical Low $138.04 Median $138.04 Typical High $204.17 | Professional | None | $138.04 | $138.04 | $204.17 |
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 $72.44 Median $74.13 Typical High $74.13 | Professional | 52 · Reduced service | $72.44 | $74.13 | $74.13 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $30.20 Typical High $30.20 | Professional | 53 · Discontinued | $28.84 | $30.20 | $30.20 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $22.39 Typical High $22.39 | Professional | 55 · Aftercare only | $21.38 | $22.39 | $22.39 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $14.79 Typical High $14.79 | Professional | 56 · Pre-op care only | $14.45 | $14.79 | $14.79 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $72.44 Median $74.13 Typical High $74.13 | Professional | 52 · Reduced service | $72.44 | $74.13 | $74.13 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $28.84 Median $30.20 Typical High $30.20 | Professional | 53 · Discontinued | $28.84 | $30.20 | $30.20 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $21.38 Median $22.39 Typical High $22.39 | Professional | 55 · Aftercare only | $21.38 | $22.39 | $22.39 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $14.45 Median $14.79 Typical High $14.79 | Professional | 56 · Pre-op care only | $14.45 | $14.79 | $14.79 |
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· 25th of 51
$145
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.