How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $1.86 Median $1.95 Typical High $1.95 | Professional | None | $1.86 | $1.95 | $1.95 |
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $0.93 Median $0.98 Typical High $0.98 | Professional | 52 · Reduced service | $0.93 | $0.98 | $0.98 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $0.37 Median $0.39 Typical High $0.39 | Professional | 53 · Discontinued | $0.37 | $0.39 | $0.39 |
Anthem BCBS Setting Facility Modifier None Typical Low $5.75 Median $5.75 Typical High $5.75 | Facility | None | $5.75 | $5.75 | $5.75 |
Anthem BCBS Setting Professional Modifier None Typical Low $1.86 Median $1.86 Typical High $1.95 | Professional | None | $1.86 | $1.86 | $1.95 |
Cigna Setting Facility Modifier None Typical Low $2.09 Median $2.09 Typical High $5.37 | Facility | None | $2.09 | $2.09 | $5.37 |
Cigna Setting Professional Modifier None Typical Low $1.86 Median $1.86 Typical High $1.86 | Professional | None | $1.86 | $1.86 | $1.86 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $1.66 Median $1.86 Typical High $2.40 | Professional | None | $1.66 | $1.86 | $2.40 |
Martin's Point Setting Professional Modifier None Typical Low $1.86 Median $1.95 Typical High $1.95 | Professional | None | $1.86 | $1.95 | $1.95 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $0.93 Median $0.98 Typical High $0.98 | Professional | 52 · Reduced service | $0.93 | $0.98 | $0.98 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $0.37 Median $0.39 Typical High $0.39 | Professional | 53 · Discontinued | $0.37 | $0.39 | $0.39 |
United Setting Professional Modifier None Typical Low $1.66 Median $1.66 Typical High $2.88 | Professional | None | $1.66 | $1.66 | $2.88 |
4 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 55 · Aftercare only Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | 55 · Aftercare only | $0.28 | $0.28 | $0.28 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $0.19 Median $0.19 Typical High $0.19 | Professional | 56 · Pre-op care only | $0.19 | $0.19 | $0.19 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $0.28 Median $0.28 Typical High $0.28 | Professional | 55 · Aftercare only | $0.28 | $0.28 | $0.28 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $0.19 Median $0.19 Typical High $0.19 | Professional | 56 · Pre-op care only | $0.19 | $0.19 | $0.19 |
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· 27th of 51
$1.86
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.