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 $28.84 Median $29.51 Typical High $29.51 | Professional | None | $28.84 | $29.51 | $29.51 |
Anthem BCBS Setting Facility Modifier None Typical Low $27.54 Median $35.48 Typical High $91.20 | Facility | None | $27.54 | $35.48 | $91.20 |
Anthem BCBS Setting Professional Modifier None Typical Low $29.51 Median $32.36 Typical High $32.36 | Professional | None | $29.51 | $32.36 | $32.36 |
Cigna Setting Facility Modifier None Typical Low $28.84 Median $39.81 Typical High $45.71 | Facility | None | $28.84 | $39.81 | $45.71 |
Cigna Setting Professional Modifier None Typical Low $32.36 Median $32.36 Typical High $32.36 | Professional | None | $32.36 | $32.36 | $32.36 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $28.84 Median $28.84 Typical High $41.69 | Professional | None | $28.84 | $28.84 | $41.69 |
Martin's Point Setting Professional Modifier None Typical Low $28.84 Median $29.51 Typical High $29.51 | Professional | None | $28.84 | $29.51 | $29.51 |
United Setting Professional Modifier None Typical Low $28.84 Median $28.84 Typical High $42.66 | Professional | None | $28.84 | $28.84 | $42.66 |
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 $14.13 Median $14.79 Typical High $14.79 | Professional | 52 · Reduced service | $14.13 | $14.79 | $14.79 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.75 Median $5.89 Typical High $5.89 | Professional | 53 · Discontinued | $5.75 | $5.89 | $5.89 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.27 Median $4.47 Typical High $4.47 | Professional | 55 · Aftercare only | $4.27 | $4.47 | $4.47 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.82 Median $2.95 Typical High $2.95 | Professional | 56 · Pre-op care only | $2.82 | $2.95 | $2.95 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $14.13 Median $14.79 Typical High $14.79 | Professional | 52 · Reduced service | $14.13 | $14.79 | $14.79 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $5.75 Median $5.89 Typical High $5.89 | Professional | 53 · Discontinued | $5.75 | $5.89 | $5.89 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $4.27 Median $4.47 Typical High $4.47 | Professional | 55 · Aftercare only | $4.27 | $4.47 | $4.47 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.82 Median $2.95 Typical High $2.95 | Professional | 56 · Pre-op care only | $2.82 | $2.95 | $2.95 |
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· 29th of 51
$31.62
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.