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 $31.62 Median $31.62 Typical High $31.62 | Facility | None | $31.62 | $31.62 | $31.62 |
Aetna Setting Professional Modifier None Typical Low $30.90 Median $31.62 Typical High $31.62 | Professional | None | $30.90 | $31.62 | $31.62 |
Anthem BCBS Setting Facility Modifier None Typical Low $29.51 Median $38.02 Typical High $95.50 | Facility | None | $29.51 | $38.02 | $95.50 |
Anthem BCBS Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $33.11 | Professional | None | $30.90 | $30.90 | $33.11 |
Cigna Setting Facility Modifier None Typical Low $30.90 Median $42.66 Typical High $43.65 | Facility | None | $30.90 | $42.66 | $43.65 |
Cigna Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $30.90 | Professional | None | $30.90 | $30.90 | $30.90 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $44.67 | Professional | None | $30.90 | $30.90 | $44.67 |
Martin's Point Setting Professional Modifier None Typical Low $30.90 Median $31.62 Typical High $31.62 | Professional | None | $30.90 | $31.62 | $31.62 |
United Setting Professional Modifier None Typical Low $30.90 Median $30.90 Typical High $45.71 | Professional | None | $30.90 | $30.90 | $45.71 |
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 $15.49 Median $15.85 Typical High $15.85 | Professional | 52 · Reduced service | $15.49 | $15.85 | $15.85 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.17 Median $6.46 Typical High $6.46 | Professional | 53 · Discontinued | $6.17 | $6.46 | $6.46 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.57 Median $4.79 Typical High $4.79 | Professional | 55 · Aftercare only | $4.57 | $4.79 | $4.79 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.09 Median $3.16 Typical High $3.16 | Professional | 56 · Pre-op care only | $3.09 | $3.16 | $3.16 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $15.49 Median $15.85 Typical High $15.85 | Professional | 52 · Reduced service | $15.49 | $15.85 | $15.85 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $6.17 Median $6.46 Typical High $6.46 | Professional | 53 · Discontinued | $6.17 | $6.46 | $6.46 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $4.57 Median $4.79 Typical High $4.79 | Professional | 55 · Aftercare only | $4.57 | $4.79 | $4.79 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.09 Median $3.16 Typical High $3.16 | Professional | 56 · Pre-op care only | $3.09 | $3.16 | $3.16 |
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· 23rd of 51
$30.90
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.