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 $229.09 Median $234.42 Typical High $234.42 | Professional | None | $229.09 | $234.42 | $234.42 |
Anthem BCBS Setting Facility Modifier None Typical Low $213.80 Median $275.42 Typical High $707.95 | Facility | None | $213.80 | $275.42 | $707.95 |
Anthem BCBS Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $245.47 | Professional | None | $229.09 | $229.09 | $245.47 |
Cigna Setting Facility Modifier None Typical Low $218.78 Median $302.00 Typical High $316.23 | Facility | None | $218.78 | $302.00 | $316.23 |
Cigna Setting Professional Modifier None Typical Low $229.09 Median $229.09 Typical High $229.09 | Professional | None | $229.09 | $229.09 | $229.09 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $223.87 Median $229.09 Typical High $323.59 | Professional | None | $223.87 | $229.09 | $323.59 |
Martin's Point Setting Professional Modifier None Typical Low $229.09 Median $234.42 Typical High $234.42 | Professional | None | $229.09 | $234.42 | $234.42 |
United Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $331.13 | Professional | None | $223.87 | $223.87 | $331.13 |
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 $112.20 Median $117.49 Typical High $117.49 | Professional | 52 · Reduced service | $112.20 | $117.49 | $117.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $46.77 Typical High $46.77 | Professional | 53 · Discontinued | $45.71 | $46.77 | $46.77 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $35.48 Typical High $35.48 | Professional | 55 · Aftercare only | $33.88 | $35.48 | $35.48 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $22.91 Median $23.44 Typical High $23.44 | Professional | 56 · Pre-op care only | $22.91 | $23.44 | $23.44 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $112.20 Median $117.49 Typical High $117.49 | Professional | 52 · Reduced service | $112.20 | $117.49 | $117.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $45.71 Median $46.77 Typical High $46.77 | Professional | 53 · Discontinued | $45.71 | $46.77 | $46.77 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $33.88 Median $35.48 Typical High $35.48 | Professional | 55 · Aftercare only | $33.88 | $35.48 | $35.48 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $22.91 Median $23.44 Typical High $23.44 | Professional | 56 · Pre-op care only | $22.91 | $23.44 | $23.44 |
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
$229
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.