How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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 $467.74 Median $512.86 Typical High $512.86 | Professional | None | $467.74 | $512.86 | $512.86 |
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 $371.54 | Professional | UE · Used equipment | $338.84 | $338.84 | $371.54 |
Cigna Setting Facility Modifier None Typical Low $524.81 Median $660.69 Typical High $660.69 | Facility | None | $524.81 | $660.69 | $660.69 |
Cigna Setting Professional Modifier None Typical Low $562.34 Median $562.34 Typical High $660.69 | Professional | None | $562.34 | $562.34 | $660.69 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $309.03 Median $660.69 Typical High $870.96 | Professional | None | $309.03 | $660.69 | $870.96 |
Martin's Point Setting Professional Modifier None Typical Low $467.74 Median $512.86 Typical High $512.86 | Professional | None | $467.74 | $512.86 | $512.86 |
United Setting Facility Modifier None Typical Low $407.38 Median $407.38 Typical High $407.38 | Facility | None | $407.38 | $407.38 | $407.38 |
United Setting Professional Modifier None Typical Low $295.12 Median $380.19 Typical High $1,047.13 | Professional | None | $295.12 | $380.19 | $1,047.13 |
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 $234.42 Median $257.04 Typical High $257.04 | Professional | 52 · Reduced service | $234.42 | $257.04 | $257.04 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $95.50 Median $102.33 Typical High $102.33 | Professional | 53 · Discontinued | $95.50 | $102.33 | $102.33 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $75.86 Typical High $75.86 | Professional | 55 · Aftercare only | $70.79 | $75.86 | $75.86 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $51.29 Typical High $51.29 | Professional | 56 · Pre-op care only | $46.77 | $51.29 | $51.29 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $234.42 Median $257.04 Typical High $257.04 | Professional | 52 · Reduced service | $234.42 | $257.04 | $257.04 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $95.50 Median $102.33 Typical High $102.33 | Professional | 53 · Discontinued | $95.50 | $102.33 | $102.33 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $70.79 Median $75.86 Typical High $75.86 | Professional | 55 · Aftercare only | $70.79 | $75.86 | $75.86 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $46.77 Median $51.29 Typical High $51.29 | Professional | 56 · Pre-op care only | $46.77 | $51.29 | $51.29 |
Where Maine sits
The same service costs 2.5 times more in Montana than in Washington, DC. 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· 39th of 51
$501
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.