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 $691.83 Median $707.95 Typical High $707.95 | Professional | None | $691.83 | $707.95 | $707.95 |
Anthem BCBS Setting Facility Modifier None Typical Low $660.69 Median $851.14 Typical High $2,137.96 | Facility | None | $660.69 | $851.14 | $2,137.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $691.83 Median $691.83 Typical High $741.31 | Professional | None | $691.83 | $691.83 | $741.31 |
Cigna Setting Facility Modifier None Typical Low $691.83 Median $912.01 Typical High $954.99 | Facility | None | $691.83 | $912.01 | $954.99 |
Cigna Setting Professional Modifier None Typical Low $691.83 Median $691.83 Typical High $691.83 | Professional | None | $691.83 | $691.83 | $691.83 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $691.83 Median $691.83 Typical High $1,000.00 | Professional | None | $691.83 | $691.83 | $1,000.00 |
Martin's Point Setting Professional Modifier None Typical Low $691.83 Median $707.95 Typical High $707.95 | Professional | None | $691.83 | $707.95 | $707.95 |
United Setting Professional Modifier None Typical Low $691.83 Median $691.83 Typical High $1,023.29 | Professional | None | $691.83 | $691.83 | $1,023.29 |
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 $338.84 Median $354.81 Typical High $354.81 | Professional | 52 · Reduced service | $338.84 | $354.81 | $354.81 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $138.04 Median $141.25 Typical High $141.25 | Professional | 53 · Discontinued | $138.04 | $141.25 | $141.25 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $102.33 Median $107.15 Typical High $107.15 | Professional | 55 · Aftercare only | $102.33 | $107.15 | $107.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $69.18 Median $70.79 Typical High $70.79 | Professional | 56 · Pre-op care only | $69.18 | $70.79 | $70.79 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $338.84 Median $354.81 Typical High $354.81 | Professional | 52 · Reduced service | $338.84 | $354.81 | $354.81 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $138.04 Median $141.25 Typical High $141.25 | Professional | 53 · Discontinued | $138.04 | $141.25 | $141.25 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $102.33 Median $107.15 Typical High $107.15 | Professional | 55 · Aftercare only | $102.33 | $107.15 | $107.15 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $69.18 Median $70.79 Typical High $70.79 | Professional | 56 · Pre-op care only | $69.18 | $70.79 | $70.79 |
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· 39th of 51
$692
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.