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 $154.88 Median $162.18 Typical High $177.83 | Professional | None | $154.88 | $162.18 | $177.83 |
Anthem BCBS Setting Facility Modifier None Typical Low $263.03 Median $338.84 Typical High $645.65 | Facility | None | $263.03 | $338.84 | $645.65 |
Anthem BCBS Setting Professional Modifier None Typical Low $158.49 Median $158.49 Typical High $173.78 | Professional | None | $158.49 | $158.49 | $173.78 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $15.85 Median $15.85 Typical High $17.38 | Professional | RR · Rental | $15.85 | $15.85 | $17.38 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $117.49 Median $117.49 Typical High $128.82 | Professional | UE · Used equipment | $117.49 | $117.49 | $128.82 |
Cigna Setting Facility Modifier None Typical Low $141.25 Median $141.25 Typical High $158.49 | Facility | None | $141.25 | $141.25 | $158.49 |
Cigna Setting Professional Modifier None Typical Low $104.71 Median $104.71 Typical High $141.25 | Professional | None | $104.71 | $104.71 | $141.25 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $104.71 Median $234.42 Typical High $309.03 | Professional | None | $104.71 | $234.42 | $309.03 |
Martin's Point Setting Professional Modifier None Typical Low $154.88 Median $162.18 Typical High $177.83 | Professional | None | $154.88 | $162.18 | $177.83 |
United Setting Professional Modifier None Typical Low $104.71 Median $134.90 Typical High $371.54 | Professional | None | $104.71 | $134.90 | $371.54 |
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 $77.62 Median $81.28 Typical High $81.28 | Professional | 52 · Reduced service | $77.62 | $81.28 | $81.28 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $30.90 Median $32.36 Typical High $32.36 | Professional | 53 · Discontinued | $30.90 | $32.36 | $32.36 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $23.44 Median $24.55 Typical High $24.55 | Professional | 55 · Aftercare only | $23.44 | $24.55 | $24.55 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $15.49 Median $16.22 Typical High $16.22 | Professional | 56 · Pre-op care only | $15.49 | $16.22 | $16.22 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $77.62 Median $81.28 Typical High $81.28 | Professional | 52 · Reduced service | $77.62 | $81.28 | $81.28 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $30.90 Median $32.36 Typical High $32.36 | Professional | 53 · Discontinued | $30.90 | $32.36 | $32.36 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $23.44 Median $24.55 Typical High $24.55 | Professional | 55 · Aftercare only | $23.44 | $24.55 | $24.55 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $15.49 Median $16.22 Typical High $16.22 | Professional | 56 · Pre-op care only | $15.49 | $16.22 | $16.22 |
Where Maine sits
The same service costs 2.2 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· 33rd of 51
$158
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.