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 $37.15 Median $40.74 Typical High $40.74 | Professional | None | $37.15 | $40.74 | $40.74 |
Anthem BCBS Setting Facility Modifier None Typical Low $66.07 Median $83.18 Typical High $158.49 | Facility | None | $66.07 | $83.18 | $158.49 |
Anthem BCBS Setting Professional Modifier None Typical Low $37.15 Median $37.15 Typical High $40.74 | Professional | None | $37.15 | $37.15 | $40.74 |
Anthem BCBS Setting Professional Modifier RR · Rental Typical Low $3.72 Median $3.72 Typical High $4.07 | Professional | RR · Rental | $3.72 | $3.72 | $4.07 |
Anthem BCBS Setting Professional Modifier UE · Used equipment Typical Low $27.54 Median $27.54 Typical High $30.20 | Professional | UE · Used equipment | $27.54 | $27.54 | $30.20 |
Cigna Setting Facility Modifier None Typical Low $40.74 Median $40.74 Typical High $48.98 | Facility | None | $40.74 | $40.74 | $48.98 |
Cigna Setting Professional Modifier None Typical Low $29.51 Median $29.51 Typical High $40.74 | Professional | None | $29.51 | $29.51 | $40.74 |
Harvard Pilgrim Setting Professional Modifier None Typical Low $25.70 Median $57.54 Typical High $75.86 | Professional | None | $25.70 | $57.54 | $75.86 |
Martin's Point Setting Professional Modifier None Typical Low $37.15 Median $40.74 Typical High $40.74 | Professional | None | $37.15 | $40.74 | $40.74 |
United Setting Facility Modifier None Typical Low $36.31 Median $36.31 Typical High $40.74 | Facility | None | $36.31 | $36.31 | $40.74 |
United Setting Professional Modifier None Typical Low $25.70 Median $33.11 Typical High $91.20 | Professional | None | $25.70 | $33.11 | $91.20 |
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 $19.50 Median $19.95 Typical High $19.95 | Professional | 52 · Reduced service | $19.50 | $19.95 | $19.95 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $8.13 Typical High $8.13 | Professional | 53 · Discontinued | $7.94 | $8.13 | $8.13 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $5.89 Median $6.03 Typical High $6.03 | Professional | 55 · Aftercare only | $5.89 | $6.03 | $6.03 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $3.89 Median $4.07 Typical High $4.07 | Professional | 56 · Pre-op care only | $3.89 | $4.07 | $4.07 |
Martin's Point Setting Professional Modifier 52 · Reduced service Typical Low $19.50 Median $19.95 Typical High $19.95 | Professional | 52 · Reduced service | $19.50 | $19.95 | $19.95 |
Martin's Point Setting Professional Modifier 53 · Discontinued Typical Low $7.94 Median $8.13 Typical High $8.13 | Professional | 53 · Discontinued | $7.94 | $8.13 | $8.13 |
Martin's Point Setting Professional Modifier 55 · Aftercare only Typical Low $5.89 Median $6.03 Typical High $6.03 | Professional | 55 · Aftercare only | $5.89 | $6.03 | $6.03 |
Martin's Point Setting Professional Modifier 56 · Pre-op care only Typical Low $3.89 Median $4.07 Typical High $4.07 | Professional | 56 · Pre-op care only | $3.89 | $4.07 | $4.07 |
Where Maine sits
The same service costs 2.7 times more in Montana than in Delaware. 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· 41st of 51
$37.15
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.