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 $177.83 Median $245.47 Typical High $245.47 | Professional | None | $177.83 | $245.47 | $245.47 |
Anthem BCBS Setting Facility Modifier None Typical Low $263.03 Median $331.13 Typical High $630.96 | Facility | None | $263.03 | $331.13 | $630.96 |
Anthem BCBS Setting Professional Modifier None Typical Low $177.83 Median $239.88 Typical High $257.04 | Professional | None | $177.83 | $239.88 | $257.04 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $20.42 Median $23.99 Typical High $26.30 | Professional | RR · Rental | $20.42 | $23.99 | $26.30 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $134.90 Median $177.83 Typical High $194.98 | Professional | UE · Used equipment | $134.90 | $177.83 | $194.98 |
Cigna Setting Facility Modifier None Typical Low $275.42 Median $275.42 Typical High $295.12 | Facility | None | $275.42 | $275.42 | $295.12 |
Cigna Setting Professional Modifier None Typical Low $204.17 Median $204.17 Typical High $275.42 | Professional | None | $204.17 | $204.17 | $275.42 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $154.88 Median $229.09 Typical High $467.74 | Professional | None | $154.88 | $229.09 | $467.74 |
Martin's Point Setting Professional Modifier None Typical Low $177.83 Median $245.47 Typical High $245.47 | Professional | None | $177.83 | $245.47 | $245.47 |
United Setting Professional Modifier None Typical Low $134.90 Median $204.17 Typical High $562.34 | Professional | None | $134.90 | $204.17 | $562.34 |
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 $93.33 Median $123.03 Typical High $123.03 | Professional | 52 · Reduced service | $93.33 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $48.98 Typical High $48.98 | Professional | 53 · Discontinued | $37.15 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $37.15 Typical High $37.15 | Professional | 55 · Aftercare only | $27.54 | $37.15 | $37.15 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $24.55 Typical High $24.55 | Professional | 56 · Pre-op care only | $18.62 | $24.55 | $24.55 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $93.33 Median $123.03 Typical High $123.03 | Professional | 52 · Reduced service | $93.33 | $123.03 | $123.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $37.15 Median $48.98 Typical High $48.98 | Professional | 53 · Discontinued | $37.15 | $48.98 | $48.98 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $27.54 Median $37.15 Typical High $37.15 | Professional | 55 · Aftercare only | $27.54 | $37.15 | $37.15 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $18.62 Median $24.55 Typical High $24.55 | Professional | 56 · Pre-op care only | $18.62 | $24.55 | $24.55 |
Where Maine sits
The same service costs 2.6 times more in Hawaii than in Utah. 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· 17th of 51
$240
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.