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 $616.60 Typical High $616.60 | Professional | None | $436.52 | $616.60 | $616.60 |
Anthem BCBS Setting Facility Modifier None Typical Low $912.01 Median $1,174.90 Typical High $2,187.76 | Facility | None | $912.01 | $1,174.90 | $2,187.76 |
Anthem BCBS Setting Professional Modifier None Typical Low $416.87 Median $416.87 Typical High $457.09 | Professional | None | $416.87 | $416.87 | $457.09 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $41.69 Median $41.69 Typical High $45.71 | Professional | RR · Rental | $41.69 | $41.69 | $45.71 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $309.03 Median $309.03 Typical High $346.74 | Professional | UE · Used equipment | $309.03 | $309.03 | $346.74 |
Cigna Setting Facility Modifier None Typical Low $501.19 Median $501.19 Typical High $676.08 | Facility | None | $501.19 | $501.19 | $676.08 |
Cigna Setting Professional Modifier None Typical Low $363.08 Median $363.08 Typical High $501.19 | Professional | None | $363.08 | $363.08 | $501.19 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $363.08 Median $812.83 Typical High $1,047.13 | Professional | None | $363.08 | $812.83 | $1,047.13 |
Martin's Point Setting Professional Modifier None Typical Low $436.52 Median $616.60 Typical High $616.60 | Professional | None | $436.52 | $616.60 | $616.60 |
United Setting Facility Modifier None Typical Low $426.58 Median $426.58 Typical High $467.74 | Facility | None | $426.58 | $426.58 | $467.74 |
United Setting Professional Modifier None Typical Low $323.59 Median $457.09 Typical High $1,288.25 | Professional | None | $323.59 | $457.09 | $1,288.25 |
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 $218.78 Median $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $218.78 | $309.03 | $309.03 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $87.10 Median $123.03 Typical High $123.03 | Professional | 53 · Discontinued | $87.10 | $123.03 | $123.03 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $93.33 Typical High $93.33 | Professional | 55 · Aftercare only | $66.07 | $93.33 | $93.33 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $61.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $43.65 | $61.66 | $61.66 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $218.78 Median $309.03 Typical High $309.03 | Professional | 52 · Reduced service | $218.78 | $309.03 | $309.03 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $87.10 Median $123.03 Typical High $123.03 | Professional | 53 · Discontinued | $87.10 | $123.03 | $123.03 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $66.07 Median $93.33 Typical High $93.33 | Professional | 55 · Aftercare only | $66.07 | $93.33 | $93.33 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $43.65 Median $61.66 Typical High $61.66 | Professional | 56 · Pre-op care only | $43.65 | $61.66 | $61.66 |
Where Maine sits
The same service costs 3.0 times more in Hawaii than in West Virginia. 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· 31st of 51
$457
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.