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 $234.42 Median $354.81 Typical High $354.81 | Professional | None | $234.42 | $354.81 | $354.81 |
Anthem BCBS Setting Facility Modifier None Typical Low $524.81 Median $676.08 Typical High $1,258.93 | Facility | None | $524.81 | $676.08 | $1,258.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $239.88 Median $239.88 Typical High $263.03 | Professional | None | $239.88 | $239.88 | $263.03 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $23.99 Median $23.99 Typical High $26.30 | Professional | RR · Rental | $23.99 | $23.99 | $26.30 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $181.97 Median $181.97 Typical High $199.53 | Professional | UE · Used equipment | $181.97 | $181.97 | $199.53 |
Cigna Setting Facility Modifier None Typical Low $309.03 Median $309.03 Typical High $389.05 | Facility | None | $309.03 | $309.03 | $389.05 |
Cigna Setting Professional Modifier None Typical Low $223.87 Median $223.87 Typical High $309.03 | Professional | None | $223.87 | $223.87 | $309.03 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $208.93 Median $467.74 Typical High $602.56 | Professional | None | $208.93 | $467.74 | $602.56 |
Martin's Point Setting Professional Modifier None Typical Low $234.42 Median $354.81 Typical High $354.81 | Professional | None | $234.42 | $354.81 | $354.81 |
United Setting Facility Modifier None Typical Low $218.78 Median $218.78 Typical High $245.47 | Facility | None | $218.78 | $218.78 | $245.47 |
United Setting Professional Modifier None Typical Low $186.21 Median $263.03 Typical High $741.31 | Professional | None | $186.21 | $263.03 | $741.31 |
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 $120.23 Median $177.83 Typical High $177.83 | Professional | 52 · Reduced service | $120.23 | $177.83 | $177.83 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $47.86 Median $70.79 Typical High $70.79 | Professional | 53 · Discontinued | $47.86 | $70.79 | $70.79 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $53.70 Typical High $53.70 | Professional | 55 · Aftercare only | $35.48 | $53.70 | $53.70 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $23.99 Median $35.48 Typical High $35.48 | Professional | 56 · Pre-op care only | $23.99 | $35.48 | $35.48 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $120.23 Median $177.83 Typical High $177.83 | Professional | 52 · Reduced service | $120.23 | $177.83 | $177.83 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $47.86 Median $70.79 Typical High $70.79 | Professional | 53 · Discontinued | $47.86 | $70.79 | $70.79 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $35.48 Median $53.70 Typical High $53.70 | Professional | 55 · Aftercare only | $35.48 | $53.70 | $53.70 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $23.99 Median $35.48 Typical High $35.48 | Professional | 56 · Pre-op care only | $23.99 | $35.48 | $35.48 |
Where Maine sits
The same service costs 2.5 times more in Hawaii than in Pennsylvania. 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· 30th of 51
$263
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.