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 $173.78 Median $239.88 Typical High $239.88 | Professional | None | $173.78 | $239.88 | $239.88 |
Anthem BCBS Setting Facility Modifier None Typical Low $234.42 Median $302.00 Typical High $575.44 | Facility | None | $234.42 | $302.00 | $575.44 |
Anthem BCBS Setting Professional Modifier None Typical Low $199.53 Median $204.17 Typical High $213.80 | Professional | None | $199.53 | $204.17 | $213.80 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $16.98 Median $19.95 Typical High $21.88 | Professional | RR · Rental | $16.98 | $19.95 | $21.88 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $120.23 Median $147.91 Typical High $158.49 | Professional | UE · Used equipment | $120.23 | $147.91 | $158.49 |
Cigna Setting Facility Modifier None Typical Low $213.80 Median $213.80 Typical High $295.12 | Facility | None | $213.80 | $213.80 | $295.12 |
Cigna Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $213.80 | Professional | None | $158.49 | $158.49 | $213.80 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $134.90 Median $208.93 Typical High $457.09 | Professional | None | $134.90 | $208.93 | $457.09 |
Martin's Point Setting Professional Modifier None Typical Low $173.78 Median $239.88 Typical High $239.88 | Professional | None | $173.78 | $239.88 | $239.88 |
United Setting Facility Modifier None Typical Low $213.80 Median $213.80 Typical High $234.42 | Facility | None | $213.80 | $213.80 | $234.42 |
United Setting Professional Modifier None Typical Low $125.89 Median $199.53 Typical High $549.54 | Professional | None | $125.89 | $199.53 | $549.54 |
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 $87.10 Median $120.23 Typical High $120.23 | Professional | 52 · Reduced service | $87.10 | $120.23 | $120.23 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $48.98 Typical High $48.98 | Professional | 53 · Discontinued | $34.67 | $48.98 | $48.98 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $36.31 Typical High $36.31 | Professional | 55 · Aftercare only | $26.30 | $36.31 | $36.31 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $23.99 Typical High $23.99 | Professional | 56 · Pre-op care only | $17.38 | $23.99 | $23.99 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $87.10 Median $120.23 Typical High $120.23 | Professional | 52 · Reduced service | $87.10 | $120.23 | $120.23 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $34.67 Median $48.98 Typical High $48.98 | Professional | 53 · Discontinued | $34.67 | $48.98 | $48.98 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $26.30 Median $36.31 Typical High $36.31 | Professional | 55 · Aftercare only | $26.30 | $36.31 | $36.31 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $17.38 Median $23.99 Typical High $23.99 | Professional | 56 · Pre-op care only | $17.38 | $23.99 | $23.99 |
Where Maine sits
The same service costs 2.9 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· 24th of 51
$204
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.