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 $81.28 Median $91.20 Typical High $102.33 | Professional | None | $81.28 | $91.20 | $102.33 |
Anthem BCBS Setting Facility Modifier None Typical Low $151.36 Median $190.55 Typical High $363.08 | Facility | None | $151.36 | $190.55 | $363.08 |
Anthem BCBS Setting Professional Modifier None Typical Low $81.28 Median $85.11 Typical High $91.20 | Professional | None | $81.28 | $85.11 | $91.20 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $8.13 Median $8.13 Typical High $9.12 | Professional | RR · Rental | $8.13 | $8.13 | $9.12 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $61.66 Median $61.66 Typical High $67.61 | Professional | UE · Used equipment | $61.66 | $61.66 | $67.61 |
Cigna Setting Facility Modifier None Typical Low $87.10 Median $87.10 Typical High $112.20 | Facility | None | $87.10 | $87.10 | $112.20 |
Cigna Setting Professional Modifier None Typical Low $63.10 Median $63.10 Typical High $87.10 | Professional | None | $63.10 | $63.10 | $87.10 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $58.88 Median $131.83 Typical High $173.78 | Professional | None | $58.88 | $131.83 | $173.78 |
Martin's Point Setting Professional Modifier None Typical Low $81.28 Median $91.20 Typical High $102.33 | Professional | None | $81.28 | $91.20 | $102.33 |
United Setting Facility Modifier None Typical Low $91.20 Median $91.20 Typical High $120.23 | Facility | None | $91.20 | $91.20 | $120.23 |
United Setting Professional Modifier None Typical Low $58.88 Median $75.86 Typical High $208.93 | Professional | None | $58.88 | $75.86 | $208.93 |
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 $42.66 Median $45.71 Typical High $45.71 | Professional | 52 · Reduced service | $42.66 | $45.71 | $45.71 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $18.62 Typical High $18.62 | Professional | 53 · Discontinued | $17.38 | $18.62 | $18.62 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $13.80 Typical High $13.80 | Professional | 55 · Aftercare only | $12.88 | $13.80 | $13.80 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $9.12 Typical High $9.12 | Professional | 56 · Pre-op care only | $8.71 | $9.12 | $9.12 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $42.66 Median $45.71 Typical High $45.71 | Professional | 52 · Reduced service | $42.66 | $45.71 | $45.71 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $17.38 Median $18.62 Typical High $18.62 | Professional | 53 · Discontinued | $17.38 | $18.62 | $18.62 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $12.88 Median $13.80 Typical High $13.80 | Professional | 55 · Aftercare only | $12.88 | $13.80 | $13.80 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $8.71 Median $9.12 Typical High $9.12 | Professional | 56 · Pre-op care only | $8.71 | $9.12 | $9.12 |
Where Maine sits
The same service costs 5.0 times more in Hawaii than in Delaware. 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· 31st of 51
$85.11
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.