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 $151.36 Median $204.17 Typical High $204.17 | Professional | None | $151.36 | $204.17 | $204.17 |
Anthem BCBS Setting Facility Modifier None Typical Low $213.80 Median $275.42 Typical High $524.81 | Facility | None | $213.80 | $275.42 | $524.81 |
Anthem BCBS Setting Professional Modifier None Typical Low $194.98 Median $194.98 Typical High $208.93 | Professional | None | $194.98 | $194.98 | $208.93 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $16.60 Median $19.50 Typical High $21.38 | Professional | RR · Rental | $16.60 | $19.50 | $21.38 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $109.65 Median $144.54 Typical High $154.88 | Professional | UE · Used equipment | $109.65 | $144.54 | $154.88 |
Cigna Setting Facility Modifier None Typical Low $213.80 Median $213.80 Typical High $229.09 | Facility | None | $213.80 | $213.80 | $229.09 |
Cigna Setting Professional Modifier None Typical Low $154.88 Median $154.88 Typical High $213.80 | Professional | None | $154.88 | $154.88 | $213.80 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $128.82 Median $190.55 Typical High $389.05 | Professional | None | $128.82 | $190.55 | $389.05 |
Martin's Point Setting Professional Modifier None Typical Low $151.36 Median $204.17 Typical High $204.17 | Professional | None | $151.36 | $204.17 | $204.17 |
United Setting Professional Modifier None Typical Low $112.20 Median $169.82 Typical High $467.74 | Professional | None | $112.20 | $169.82 | $467.74 |
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 $75.86 Median $102.33 Typical High $102.33 | Professional | 52 · Reduced service | $75.86 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.90 Median $40.74 Typical High $40.74 | Professional | 53 · Discontinued | $30.90 | $40.74 | $40.74 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $22.91 Median $30.90 Typical High $30.90 | Professional | 55 · Aftercare only | $22.91 | $30.90 | $30.90 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $20.42 Typical High $20.42 | Professional | 56 · Pre-op care only | $15.14 | $20.42 | $20.42 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $75.86 Median $102.33 Typical High $102.33 | Professional | 52 · Reduced service | $75.86 | $102.33 | $102.33 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $30.90 Median $40.74 Typical High $40.74 | Professional | 53 · Discontinued | $30.90 | $40.74 | $40.74 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $22.91 Median $30.90 Typical High $30.90 | Professional | 55 · Aftercare only | $22.91 | $30.90 | $30.90 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $15.14 Median $20.42 Typical High $20.42 | Professional | 56 · Pre-op care only | $15.14 | $20.42 | $20.42 |
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· 20th of 51
$195
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.