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 $208.93 Median $302.00 Typical High $302.00 | Professional | None | $208.93 | $302.00 | $302.00 |
Anthem BCBS Setting Facility Modifier None Typical Low $436.52 Median $562.34 Typical High $1,071.52 | Facility | None | $436.52 | $562.34 | $1,071.52 |
Anthem BCBS Setting Professional Modifier None Typical Low $218.78 Median $218.78 Typical High $239.88 | Professional | None | $218.78 | $218.78 | $239.88 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $21.88 Median $21.88 Typical High $23.99 | Professional | RR · Rental | $21.88 | $21.88 | $23.99 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $162.18 Median $162.18 Typical High $181.97 | Professional | UE · Used equipment | $162.18 | $162.18 | $181.97 |
Cigna Setting Facility Modifier None Typical Low $245.47 Median $245.47 Typical High $331.13 | Facility | None | $245.47 | $245.47 | $331.13 |
Cigna Setting Professional Modifier None Typical Low $177.83 Median $177.83 Typical High $245.47 | Professional | None | $177.83 | $177.83 | $245.47 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $173.78 Median $389.05 Typical High $512.86 | Professional | None | $173.78 | $389.05 | $512.86 |
Martin's Point Setting Professional Modifier None Typical Low $208.93 Median $302.00 Typical High $302.00 | Professional | None | $208.93 | $302.00 | $302.00 |
United Setting Facility Modifier None Typical Low $234.42 Median $234.42 Typical High $281.84 | Facility | None | $234.42 | $234.42 | $281.84 |
United Setting Professional Modifier None Typical Low $162.18 Median $223.87 Typical High $524.81 | Professional | None | $162.18 | $223.87 | $524.81 |
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 $104.71 Median $151.36 Typical High $151.36 | Professional | 52 · Reduced service | $104.71 | $151.36 | $151.36 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $60.26 Typical High $60.26 | Professional | 53 · Discontinued | $41.69 | $60.26 | $60.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $44.67 Typical High $44.67 | Professional | 55 · Aftercare only | $31.62 | $44.67 | $44.67 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $20.89 Median $30.20 Typical High $30.20 | Professional | 56 · Pre-op care only | $20.89 | $30.20 | $30.20 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $104.71 Median $151.36 Typical High $151.36 | Professional | 52 · Reduced service | $104.71 | $151.36 | $151.36 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $41.69 Median $60.26 Typical High $60.26 | Professional | 53 · Discontinued | $41.69 | $60.26 | $60.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $31.62 Median $44.67 Typical High $44.67 | Professional | 55 · Aftercare only | $31.62 | $44.67 | $44.67 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $20.89 Median $30.20 Typical High $30.20 | Professional | 56 · Pre-op care only | $20.89 | $30.20 | $30.20 |
Where Maine sits
The same service costs 3.6 times more in Hawaii than in Tennessee. 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
$240
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.