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 Facility Modifier None Typical Low $26.92 Median $26.92 Typical High $26.92 | Facility | None | $26.92 | $26.92 | $26.92 |
Aetna Setting Professional Modifier None Typical Low $25.70 Median $26.92 Typical High $54.95 | Professional | None | $25.70 | $26.92 | $54.95 |
Anthem BCBS Setting Facility Modifier None Typical Low $25.12 Median $32.36 Typical High $79.43 | Facility | None | $25.12 | $32.36 | $79.43 |
Anthem BCBS Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $26.92 | Professional | None | $25.70 | $25.70 | $26.92 |
Cigna Setting Facility Modifier None Typical Low $25.70 Median $32.36 Typical High $36.31 | Facility | None | $25.70 | $32.36 | $36.31 |
Cigna Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $25.70 | Professional | None | $25.70 | $25.70 | $25.70 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $37.15 | Professional | None | $25.70 | $25.70 | $37.15 |
Martin's Point Setting Professional Modifier None Typical Low $25.70 Median $26.92 Typical High $54.95 | Professional | None | $25.70 | $26.92 | $54.95 |
United Setting Professional Modifier None Typical Low $25.70 Median $25.70 Typical High $45.71 | Professional | None | $25.70 | $25.70 | $45.71 |
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 $12.88 Median $13.49 Typical High $13.49 | Professional | 52 · Reduced service | $12.88 | $13.49 | $13.49 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $5.13 Median $5.37 Typical High $5.37 | Professional | 53 · Discontinued | $5.13 | $5.37 | $5.37 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $3.89 Median $4.07 Typical High $4.07 | Professional | 55 · Aftercare only | $3.89 | $4.07 | $4.07 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $2.57 Median $2.69 Typical High $2.69 | Professional | 56 · Pre-op care only | $2.57 | $2.69 | $2.69 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $12.88 Median $13.49 Typical High $13.49 | Professional | 52 · Reduced service | $12.88 | $13.49 | $13.49 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $5.13 Median $5.37 Typical High $5.37 | Professional | 53 · Discontinued | $5.13 | $5.37 | $5.37 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $3.89 Median $4.07 Typical High $4.07 | Professional | 55 · Aftercare only | $3.89 | $4.07 | $4.07 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $2.57 Median $2.69 Typical High $2.69 | Professional | 56 · Pre-op care only | $2.57 | $2.69 | $2.69 |
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· 24th of 51
$25.70
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.