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 $54.95 Median $57.54 Typical High $57.54 | Professional | None | $54.95 | $57.54 | $57.54 |
Anthem BCBS Setting Facility Modifier None Typical Low $53.70 Median $69.18 Typical High $169.82 | Facility | None | $53.70 | $69.18 | $169.82 |
Anthem BCBS Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $60.26 | Professional | None | $54.95 | $54.95 | $60.26 |
Cigna Setting Facility Modifier None Typical Low $54.95 Median $77.62 Typical High $102.33 | Facility | None | $54.95 | $77.62 | $102.33 |
Cigna Setting Professional Modifier None Typical Low $54.95 Median $54.95 Typical High $54.95 | Professional | None | $54.95 | $54.95 | $54.95 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $54.95 Median $56.23 Typical High $81.28 | Professional | None | $54.95 | $56.23 | $81.28 |
Martin's Point Setting Professional Modifier None Typical Low $54.95 Median $57.54 Typical High $58.88 | Professional | None | $54.95 | $57.54 | $58.88 |
United Setting Professional Modifier None Typical Low $56.23 Median $56.23 Typical High $87.10 | Professional | None | $56.23 | $56.23 | $87.10 |
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 $27.54 Median $28.84 Typical High $28.84 | Professional | 52 · Reduced service | $27.54 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.96 Median $11.48 Typical High $11.48 | Professional | 53 · Discontinued | $10.96 | $11.48 | $11.48 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $8.32 Median $8.51 Typical High $8.51 | Professional | 55 · Aftercare only | $8.32 | $8.51 | $8.51 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.50 Median $5.75 Typical High $5.75 | Professional | 56 · Pre-op care only | $5.50 | $5.75 | $5.75 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $27.54 Median $28.84 Typical High $28.84 | Professional | 52 · Reduced service | $27.54 | $28.84 | $28.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.96 Median $11.48 Typical High $11.48 | Professional | 53 · Discontinued | $10.96 | $11.48 | $11.48 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $8.32 Median $8.51 Typical High $8.51 | Professional | 55 · Aftercare only | $8.32 | $8.51 | $8.51 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.50 Median $5.75 Typical High $5.75 | Professional | 56 · Pre-op care only | $5.50 | $5.75 | $5.75 |
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· 45th of 51
$54.95
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.