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 $575.44 Median $812.83 Typical High $812.83 | Professional | None | $575.44 | $812.83 | $812.83 |
Anthem BCBS Setting Facility Modifier None Typical Low $1,318.26 Median $1,659.59 Typical High $3,162.28 | Facility | None | $1,318.26 | $1,659.59 | $3,162.28 |
Anthem BCBS Setting Professional Modifier None Typical Low $602.56 Median $616.60 Typical High $660.69 | Professional | None | $602.56 | $616.60 | $660.69 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $60.26 Median $60.26 Typical High $66.07 | Professional | RR · Rental | $60.26 | $60.26 | $66.07 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $457.09 Median $457.09 Typical High $501.19 | Professional | UE · Used equipment | $457.09 | $457.09 | $501.19 |
Cigna Setting Facility Modifier None Typical Low $616.60 Median $616.60 Typical High $977.24 | Facility | None | $616.60 | $616.60 | $977.24 |
Cigna Setting Professional Modifier None Typical Low $457.09 Median $457.09 Typical High $616.60 | Professional | None | $457.09 | $457.09 | $616.60 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $512.86 Median $1,148.15 Typical High $1,513.56 | Professional | None | $512.86 | $1,148.15 | $1,513.56 |
Martin's Point Setting Professional Modifier None Typical Low $575.44 Median $812.83 Typical High $812.83 | Professional | None | $575.44 | $812.83 | $812.83 |
United Setting Facility Modifier None Typical Low $645.65 Median $645.65 Typical High $660.69 | Facility | None | $645.65 | $645.65 | $660.69 |
United Setting Professional Modifier None Typical Low $467.74 Median $660.69 Typical High $1,819.70 | Professional | None | $467.74 | $660.69 | $1,819.70 |
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 $295.12 Median $398.11 Typical High $398.11 | Professional | 52 · Reduced service | $295.12 | $398.11 | $398.11 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $120.23 Median $162.18 Typical High $162.18 | Professional | 53 · Discontinued | $120.23 | $162.18 | $162.18 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $89.13 Median $120.23 Typical High $120.23 | Professional | 55 · Aftercare only | $89.13 | $120.23 | $120.23 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $60.26 Median $81.28 Typical High $81.28 | Professional | 56 · Pre-op care only | $60.26 | $81.28 | $81.28 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $295.12 Median $398.11 Typical High $398.11 | Professional | 52 · Reduced service | $295.12 | $398.11 | $398.11 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $120.23 Median $162.18 Typical High $162.18 | Professional | 53 · Discontinued | $120.23 | $162.18 | $162.18 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $89.13 Median $120.23 Typical High $120.23 | Professional | 55 · Aftercare only | $89.13 | $120.23 | $120.23 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $60.26 Median $81.28 Typical High $81.28 | Professional | 56 · Pre-op care only | $60.26 | $81.28 | $81.28 |
Where Maine sits
The same service costs 3.6 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· 28th of 51
$631
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.