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 $32.36 Median $33.88 Typical High $33.88 | Professional | None | $32.36 | $33.88 | $33.88 |
Anthem BCBS Setting Facility Modifier None Typical Low $31.62 Median $40.74 Typical High $100.00 | Facility | None | $31.62 | $40.74 | $100.00 |
Anthem BCBS Setting Professional Modifier None Typical Low $32.36 Median $32.36 Typical High $35.48 | Professional | None | $32.36 | $32.36 | $35.48 |
Cigna Setting Facility Modifier None Typical Low $36.31 Median $36.31 Typical High $93.33 | Facility | None | $36.31 | $36.31 | $93.33 |
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 $32.36 Median $32.36 Typical High $46.77 | Professional | None | $32.36 | $32.36 | $46.77 |
Martin's Point Setting Professional Modifier None Typical Low $32.36 Median $33.88 Typical High $33.88 | Professional | None | $32.36 | $33.88 | $33.88 |
United Setting Professional Modifier None Typical Low $32.36 Median $32.36 Typical High $48.98 | Professional | None | $32.36 | $32.36 | $48.98 |
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 $16.22 Median $16.98 Typical High $16.98 | Professional | 52 · Reduced service | $16.22 | $16.98 | $16.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $6.46 Median $6.76 Typical High $6.76 | Professional | 53 · Discontinued | $6.46 | $6.76 | $6.76 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $4.90 Median $5.13 Typical High $5.13 | Professional | 55 · Aftercare only | $4.90 | $5.13 | $5.13 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.24 Median $3.39 Typical High $3.39 | Professional | 56 · Pre-op care only | $3.24 | $3.39 | $3.39 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $16.22 Median $16.98 Typical High $16.98 | Professional | 52 · Reduced service | $16.22 | $16.98 | $16.98 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $6.46 Median $6.76 Typical High $6.76 | Professional | 53 · Discontinued | $6.46 | $6.76 | $6.76 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $4.90 Median $5.13 Typical High $5.13 | Professional | 55 · Aftercare only | $4.90 | $5.13 | $5.13 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.24 Median $3.39 Typical High $3.39 | Professional | 56 · Pre-op care only | $3.24 | $3.39 | $3.39 |
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
$32.36
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.