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 $251.19 Median $338.84 Typical High $338.84 | Professional | None | $251.19 | $338.84 | $338.84 |
Anthem BCBS Setting Facility Modifier None Typical Low $501.19 Median $645.65 Typical High $1,230.27 | Facility | None | $501.19 | $645.65 | $1,230.27 |
Anthem BCBS Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $295.12 | Professional | None | $269.15 | $269.15 | $295.12 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $26.92 Median $26.92 Typical High $29.51 | Professional | RR · Rental | $26.92 | $26.92 | $29.51 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $199.53 Median $199.53 Typical High $218.78 | Professional | UE · Used equipment | $199.53 | $199.53 | $218.78 |
Cigna Setting Facility Modifier None Typical Low $354.81 Median $363.08 Typical High $371.54 | Facility | None | $354.81 | $363.08 | $371.54 |
Cigna Setting Professional Modifier None Typical Low $269.15 Median $269.15 Typical High $363.08 | Professional | None | $269.15 | $269.15 | $363.08 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $199.53 Median $446.68 Typical High $588.84 | Professional | None | $199.53 | $446.68 | $588.84 |
Martin's Point Setting Professional Modifier None Typical Low $251.19 Median $338.84 Typical High $338.84 | Professional | None | $251.19 | $338.84 | $338.84 |
United Setting Facility Modifier None Typical Low $165.96 Median $165.96 Typical High $223.87 | Facility | None | $165.96 | $165.96 | $223.87 |
United Setting Professional Modifier None Typical Low $199.53 Median $251.19 Typical High $707.95 | Professional | None | $199.53 | $251.19 | $707.95 |
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 $131.83 Median $169.82 Typical High $169.82 | Professional | 52 · Reduced service | $131.83 | $169.82 | $169.82 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $52.48 Median $67.61 Typical High $67.61 | Professional | 53 · Discontinued | $52.48 | $67.61 | $67.61 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $38.90 Median $51.29 Typical High $51.29 | Professional | 55 · Aftercare only | $38.90 | $51.29 | $51.29 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $26.30 Median $33.88 Typical High $33.88 | Professional | 56 · Pre-op care only | $26.30 | $33.88 | $33.88 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $131.83 Median $169.82 Typical High $169.82 | Professional | 52 · Reduced service | $131.83 | $169.82 | $169.82 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $52.48 Median $67.61 Typical High $67.61 | Professional | 53 · Discontinued | $52.48 | $67.61 | $67.61 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $38.90 Median $51.29 Typical High $51.29 | Professional | 55 · Aftercare only | $38.90 | $51.29 | $51.29 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $26.30 Median $33.88 Typical High $33.88 | Professional | 56 · Pre-op care only | $26.30 | $33.88 | $33.88 |
Where Maine sits
The same service costs 2.2 times more in Wisconsin 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· 29th of 51
$295
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.