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 $5,754.40 Median $6,606.93 Typical High $6,606.93 | Professional | None | $5,754.40 | $6,606.93 | $6,606.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $3,630.78 Median $4,897.79 Typical High $5,370.32 | Professional | None | $3,630.78 | $4,897.79 | $5,370.32 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $363.08 Median $489.78 Typical High $537.03 | Professional | RR · Rental | $363.08 | $489.78 | $537.03 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $2,754.23 Median $3,630.78 Typical High $3,981.07 | Professional | UE · Used equipment | $2,754.23 | $3,630.78 | $3,981.07 |
Cigna Setting Facility Modifier None Typical Low $5,623.41 Median $5,623.41 Typical High $6,025.60 | Facility | None | $5,623.41 | $5,623.41 | $6,025.60 |
Cigna Setting Professional Modifier None Typical Low $4,786.30 Median $4,786.30 Typical High $5,623.41 | Professional | None | $4,786.30 | $4,786.30 | $5,623.41 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $3,801.89 Median $8,511.38 Typical High $11,220.18 | Professional | None | $3,801.89 | $8,511.38 | $11,220.18 |
Martin's Point Setting Professional Modifier None Typical Low $5,754.40 Median $6,606.93 Typical High $6,606.93 | Professional | None | $5,754.40 | $6,606.93 | $6,606.93 |
United Setting Professional Modifier None Typical Low $3,801.89 Median $4,897.79 Typical High $13,489.63 | Professional | None | $3,801.89 | $4,897.79 | $13,489.63 |
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 $2,818.38 Median $3,311.31 Typical High $3,311.31 | Professional | 52 · Reduced service | $2,818.38 | $3,311.31 | $3,311.31 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $1,148.15 Median $1,318.26 Typical High $1,318.26 | Professional | 53 · Discontinued | $1,148.15 | $1,318.26 | $1,318.26 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $851.14 Median $1,000.00 Typical High $1,000.00 | Professional | 55 · Aftercare only | $851.14 | $1,000.00 | $1,000.00 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $575.44 Median $660.69 Typical High $660.69 | Professional | 56 · Pre-op care only | $575.44 | $660.69 | $660.69 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $2,818.38 Median $3,311.31 Typical High $3,311.31 | Professional | 52 · Reduced service | $2,818.38 | $3,311.31 | $3,311.31 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $1,148.15 Median $1,318.26 Typical High $1,318.26 | Professional | 53 · Discontinued | $1,148.15 | $1,318.26 | $1,318.26 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $851.14 Median $1,000.00 Typical High $1,000.00 | Professional | 55 · Aftercare only | $851.14 | $1,000.00 | $1,000.00 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $575.44 Median $660.69 Typical High $660.69 | Professional | 56 · Pre-op care only | $575.44 | $660.69 | $660.69 |
Where Maine sits
The same service costs 2.6 times more in Montana than in New York. 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· 45th of 51
$4,898
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.