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 $48.98 Median $53.70 Typical High $53.70 | Professional | None | $48.98 | $53.70 | $53.70 |
Anthem BCBS Setting Facility Modifier None Typical Low $87.10 Median $112.20 Typical High $208.93 | Facility | None | $87.10 | $112.20 | $208.93 |
Anthem BCBS Setting Professional Modifier None Typical Low $52.48 Median $53.70 Typical High $57.54 | Professional | None | $52.48 | $53.70 | $57.54 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $5.25 Median $5.25 Typical High $5.75 | Professional | RR · Rental | $5.25 | $5.25 | $5.75 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $39.81 Median $39.81 Typical High $43.65 | Professional | UE · Used equipment | $39.81 | $39.81 | $43.65 |
Cigna Setting Facility Modifier None Typical Low $61.66 Median $66.07 Typical High $66.07 | Facility | None | $61.66 | $66.07 | $66.07 |
Cigna Setting Professional Modifier None Typical Low $48.98 Median $48.98 Typical High $66.07 | Professional | None | $48.98 | $48.98 | $66.07 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $36.31 Median $77.62 Typical High $100.00 | Professional | None | $36.31 | $77.62 | $100.00 |
Martin's Point Setting Professional Modifier None Typical Low $48.98 Median $53.70 Typical High $53.70 | Professional | None | $48.98 | $53.70 | $53.70 |
United Setting Facility Modifier None Typical Low $47.86 Median $47.86 Typical High $58.88 | Facility | None | $47.86 | $47.86 | $58.88 |
United Setting Professional Modifier None Typical Low $34.67 Median $43.65 Typical High $123.03 | Professional | None | $34.67 | $43.65 | $123.03 |
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 $26.30 Median $26.92 Typical High $26.92 | Professional | 52 · Reduced service | $26.30 | $26.92 | $26.92 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $10.72 Typical High $10.72 | Professional | 53 · Discontinued | $10.47 | $10.72 | $10.72 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $7.94 Typical High $7.94 | Professional | 55 · Aftercare only | $7.94 | $7.94 | $7.94 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $5.37 Typical High $5.37 | Professional | 56 · Pre-op care only | $5.25 | $5.37 | $5.37 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $26.30 Median $26.92 Typical High $26.92 | Professional | 52 · Reduced service | $26.30 | $26.92 | $26.92 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $10.47 Median $10.72 Typical High $10.72 | Professional | 53 · Discontinued | $10.47 | $10.72 | $10.72 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $7.94 Median $7.94 Typical High $7.94 | Professional | 55 · Aftercare only | $7.94 | $7.94 | $7.94 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $5.25 Median $5.37 Typical High $5.37 | Professional | 56 · Pre-op care only | $5.25 | $5.37 | $5.37 |
Where Maine sits
The same service costs 3.4 times more in Hawaii than in Vermont. 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· 36th of 51
$53.70
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.