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 $56.23 Median $58.88 Typical High $58.88 | Professional | None | $56.23 | $58.88 | $58.88 |
Anthem BCBS Setting Facility Modifier None Typical Low $51.29 Median $66.07 Typical High $169.82 | Facility | None | $51.29 | $66.07 | $169.82 |
Anthem BCBS Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $61.66 | Professional | None | $56.23 | $56.23 | $61.66 |
Cigna Setting Facility Modifier None Typical Low $53.70 Median $69.18 Typical High $79.43 | Facility | None | $53.70 | $69.18 | $79.43 |
Cigna Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $56.23 | Professional | None | $56.23 | $56.23 | $56.23 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $53.70 Median $56.23 Typical High $77.62 | Professional | None | $53.70 | $56.23 | $77.62 |
Martin's Point Setting Professional Modifier None Typical Low $56.23 Median $58.88 Typical High $58.88 | Professional | None | $56.23 | $58.88 | $58.88 |
United Setting Professional Modifier None Typical Low $53.70 Median $53.70 Typical High $79.43 | Professional | None | $53.70 | $53.70 | $79.43 |
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 $28.18 Median $29.51 Typical High $29.51 | Professional | 52 · Reduced service | $28.18 | $29.51 | $29.51 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $11.22 Median $11.75 Typical High $11.75 | Professional | 53 · Discontinued | $11.22 | $11.75 | $11.75 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $8.71 Typical High $8.71 | Professional | 55 · Aftercare only | $8.51 | $8.71 | $8.71 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.62 Median $5.89 Typical High $5.89 | Professional | 56 · Pre-op care only | $5.62 | $5.89 | $5.89 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $28.18 Median $29.51 Typical High $29.51 | Professional | 52 · Reduced service | $28.18 | $29.51 | $29.51 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $11.22 Median $11.75 Typical High $11.75 | Professional | 53 · Discontinued | $11.22 | $11.75 | $11.75 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $8.51 Median $8.71 Typical High $8.71 | Professional | 55 · Aftercare only | $8.51 | $8.71 | $8.71 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.62 Median $5.89 Typical High $5.89 | Professional | 56 · Pre-op care only | $5.62 | $5.89 | $5.89 |
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· 47th of 51
$56.23
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.