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 $436.52 Median $676.08 Typical High $676.08 | Professional | None | $436.52 | $676.08 | $676.08 |
Anthem BCBS Setting Facility Modifier None Typical Low $977.24 Median $1,258.93 Typical High $2,398.83 | Facility | None | $977.24 | $1,258.93 | $2,398.83 |
Anthem BCBS Setting Professional Modifier None Typical Low $457.09 Median $457.09 Typical High $501.19 | Professional | None | $457.09 | $457.09 | $501.19 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $45.71 Median $45.71 Typical High $50.12 | Professional | RR · Rental | $45.71 | $45.71 | $50.12 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $338.84 Median $338.84 Typical High $380.19 | Professional | UE · Used equipment | $338.84 | $338.84 | $380.19 |
Cigna Setting Facility Modifier None Typical Low $489.78 Median $489.78 Typical High $741.31 | Facility | None | $489.78 | $489.78 | $741.31 |
Cigna Setting Professional Modifier None Typical Low $354.81 Median $354.81 Typical High $489.78 | Professional | None | $354.81 | $354.81 | $489.78 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $389.05 Median $870.96 Typical High $1,148.15 | Professional | None | $389.05 | $870.96 | $1,148.15 |
Martin's Point Setting Professional Modifier None Typical Low $436.52 Median $676.08 Typical High $676.08 | Professional | None | $436.52 | $676.08 | $676.08 |
United Setting Facility Modifier None Typical Low $489.78 Median $489.78 Typical High $501.19 | Facility | None | $489.78 | $489.78 | $501.19 |
United Setting Professional Modifier None Typical Low $354.81 Median $501.19 Typical High $1,380.38 | Professional | None | $354.81 | $501.19 | $1,380.38 |
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 $223.87 Median $338.84 Typical High $338.84 | Professional | 52 · Reduced service | $223.87 | $338.84 | $338.84 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $91.20 Median $134.90 Typical High $134.90 | Professional | 53 · Discontinued | $91.20 | $134.90 | $134.90 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $100.00 Typical High $100.00 | Professional | 55 · Aftercare only | $67.61 | $100.00 | $100.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $44.67 Median $67.61 Typical High $67.61 | Professional | 56 · Pre-op care only | $44.67 | $67.61 | $67.61 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $223.87 Median $338.84 Typical High $338.84 | Professional | 52 · Reduced service | $223.87 | $338.84 | $338.84 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $91.20 Median $134.90 Typical High $134.90 | Professional | 53 · Discontinued | $91.20 | $134.90 | $134.90 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $67.61 Median $100.00 Typical High $100.00 | Professional | 55 · Aftercare only | $67.61 | $100.00 | $100.00 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $44.67 Median $67.61 Typical High $67.61 | Professional | 56 · Pre-op care only | $44.67 | $67.61 | $67.61 |
Where Maine sits
The same service costs 3.5 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· 30th of 51
$479
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.