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 $1,258.93 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,258.93 | $1,288.25 | $1,288.25 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,230.27 Median $1,584.89 Typical High $2,630.27 | Facility | None | $1,230.27 | $1,584.89 | $2,630.27 |
Anthem BCBS Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,348.96 | Professional | None | $1,258.93 | $1,258.93 | $1,348.96 |
Cigna Setting Facility Modifier None Typical Low $1,318.26 Median $1,778.28 Typical High $1,949.84 | Facility | None | $1,318.26 | $1,778.28 | $1,949.84 |
Cigna Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,258.93 | Professional | None | $1,258.93 | $1,258.93 | $1,258.93 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,862.09 | Professional | None | $1,258.93 | $1,258.93 | $1,862.09 |
Martin's Point Setting Professional Modifier None Typical Low $1,258.93 Median $1,288.25 Typical High $1,288.25 | Professional | None | $1,258.93 | $1,288.25 | $1,288.25 |
United Setting Professional Modifier None Typical Low $1,258.93 Median $1,258.93 Typical High $1,905.46 | Professional | None | $1,258.93 | $1,258.93 | $1,905.46 |
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 $616.60 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $616.60 | $645.65 | $645.65 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $251.19 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $194.98 Typical High $194.98 | Professional | 55 · Aftercare only | $186.21 | $194.98 | $194.98 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $128.82 Typical High $128.82 | Professional | 56 · Pre-op care only | $125.89 | $128.82 | $128.82 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $616.60 Median $645.65 Typical High $645.65 | Professional | 52 · Reduced service | $616.60 | $645.65 | $645.65 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $251.19 Median $257.04 Typical High $257.04 | Professional | 53 · Discontinued | $251.19 | $257.04 | $257.04 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $186.21 Median $194.98 Typical High $194.98 | Professional | 55 · Aftercare only | $186.21 | $194.98 | $194.98 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $125.89 Median $128.82 Typical High $128.82 | Professional | 56 · Pre-op care only | $125.89 | $128.82 | $128.82 |
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
$1,259
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.