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 $38.02 Median $38.90 Typical High $40.74 | Professional | None | $38.02 | $38.90 | $40.74 |
Anthem BCBS Setting Facility Modifier None Typical Low $35.48 Median $45.71 Typical High $117.49 | Facility | None | $35.48 | $45.71 | $117.49 |
Anthem BCBS Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $40.74 | Professional | None | $38.02 | $38.02 | $40.74 |
Cigna Setting Facility Modifier None Typical Low $37.15 Median $50.12 Typical High $52.48 | Facility | None | $37.15 | $50.12 | $52.48 |
Cigna Setting Professional Modifier None Typical Low $38.02 Median $38.02 Typical High $38.02 | Professional | None | $38.02 | $38.02 | $38.02 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $37.15 Median $38.02 Typical High $53.70 | Professional | None | $37.15 | $38.02 | $53.70 |
Martin's Point Setting Professional Modifier None Typical Low $38.02 Median $38.90 Typical High $39.81 | Professional | None | $38.02 | $38.90 | $39.81 |
United Setting Professional Modifier None Typical Low $37.15 Median $37.15 Typical High $54.95 | Professional | None | $37.15 | $37.15 | $54.95 |
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 $18.62 Median $19.50 Typical High $19.50 | Professional | 52 · Reduced service | $18.62 | $19.50 | $19.50 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.59 Median $7.76 Typical High $7.76 | Professional | 53 · Discontinued | $7.59 | $7.76 | $7.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $5.89 Typical High $5.89 | Professional | 55 · Aftercare only | $5.62 | $5.89 | $5.89 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.80 Median $3.89 Typical High $3.89 | Professional | 56 · Pre-op care only | $3.80 | $3.89 | $3.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $18.62 Median $19.50 Typical High $19.50 | Professional | 52 · Reduced service | $18.62 | $19.50 | $19.50 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $7.59 Median $7.76 Typical High $7.76 | Professional | 53 · Discontinued | $7.59 | $7.76 | $7.76 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $5.62 Median $5.89 Typical High $5.89 | Professional | 55 · Aftercare only | $5.62 | $5.89 | $5.89 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.80 Median $3.89 Typical High $3.89 | Professional | 56 · Pre-op care only | $3.80 | $3.89 | $3.89 |
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· 48th of 51
$38.02
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.